World Journal of Urology最新文献

{"title":"Research progress on intratumoral microorganisms in renal cancer.","authors":"Jiankun Zhang, Keyuan Lou, Junpeng Chi, Jitao Wu, Xinying Fan, Yuanshan Cui","doi":"10.1007/s00345-024-05403-5","DOIUrl":"https://doi.org/10.1007/s00345-024-05403-5","url":null,"abstract":"<p><p>The human body harbors a vast array of microorganisms. Changes in the microbial ecosystem can potentially lead to diseases, including cancer. Traditionally, research has focused more on the gut microbiota and its influence on cancer. However, with the advancement of sequencing technologies, scholars have discovered that microorganisms within kidney tissues are significant components of tumor tissues. Intratumoral microorganisms may affect tumor growth and development through certain mechanisms, influence the function of immune cells, or impact the effectiveness of chemotherapy or immunotherapy in patients. This paper reviews the latest progress in the research on intratumoral microorganisms in renal cancer (RCa). It summarizes the types and distribution characteristics of these microorganisms, discusses the close association between specific viral infections (such as HPV and EBV) and RCa, and highlights the role of microorganisms in the pathogenesis of RCa. This review provides new perspectives for understanding the pathogenic mechanisms of RCa, thereby offering potential clinical applications.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"72"},"PeriodicalIF":2.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of kidney disease on peri-operative outcomes of novel BPH surgeries across the board: a propensity score matched analysis using the ACS-NSQIP database.","authors":"Oussama G Nasrallah, Maya T Herrera, Nassib F Abou Heidar, Jana H Mahdi, Rami W Nasr","doi":"10.1007/s00345-024-05430-2","DOIUrl":"https://doi.org/10.1007/s00345-024-05430-2","url":null,"abstract":"<p><strong>Background: </strong>Pre-operative kidney disease was shown to impact peri-operative outcomes of endoscopic BPH surgeries. We aim to assess the effect of novel surgical techniques (Laser Enucleation of the Prostate (LEP) and Laser Vaporization of the Prostate (LVP)) compared to Transurethral Resection of Prostate (TURP), on post-operative outcomes stratified based on kidney function.</p><p><strong>Methods: </strong>The ACS-NSQIP database was reviewed from 2008 to 2021 for 83,020 patients that underwent TURP, LEP, and LVP. Pre-operative variables were compared across kidney function groups: G1(normal/high function); G2-G3(mild/moderate kidney disease); and G4-G5(severe kidney disease). Multivariate logistic regression was performed on 30-day peri-operative complications adjusting for pre-operative variables. Propensity score matching was done between LEP and LVP to TURP.</p><p><strong>Results: </strong>LEP showed a protective effect against UTIs (p < 0.05) in the G1 and G2-G3 categories but lost that protective effect in the G4-G5 category when compared to TURP. It had longer operative time (p < 0.05) across all kidney function groups, and demonstrated shorter hospital stay (p < 0.05) in the G1 and G2-G3 categories compared to TURP. LVP had a persistent protective effect against bleeding (p < 0.05) across all kidney function groups and shorter hospital stay (p < 0.05) when compared to TURP. LVP had a protective effect against return to OR (p < 0.05) in the G1 and G2-G3 kidney function group but lost that protective effect in the G4-G5 category. LVP had significant protective effect against thromboembolic events (p < 0.05) in the G2-G3 category and against cardiac complications (p < 0.05) in the G4-G5 category.</p><p><strong>Conclusion: </strong>LEP and LVP are superior to TURP in terms of post-operative complications. The type of endoscopic surgery technique should be tailored according to patient's pre-operative kidney status and risk.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"73"},"PeriodicalIF":2.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcome of BCG treatment for patients with urothelial carcinoma of the prostatic urethra: Implications for early cystectomy.","authors":"Ryo Yamashita, Takashi Sugino, Akifumi Notsu, Kana Ito, Yuma Sakura, Hideo Shinsaka, Masato Matsuzaki, Masashi Niwakawa, Eiji Kikuchi","doi":"10.1007/s00345-024-05436-w","DOIUrl":"https://doi.org/10.1007/s00345-024-05436-w","url":null,"abstract":"<p><strong>Purposes: </strong>This study aimed to clarify the clinical outcomes of Bacillus Calmette-Guérin (BCG) treatment in patients with urothelial carcinoma (UC) of the prostatic urethra.</p><p><strong>Methods: </strong>Between August 2003 and January 2023, 428 patients with non-muscle-invasive UC received BCG treatment (Tokyo strain, 80 mg, ≥ 5 times) in our hospital; 39 had UC of the prostatic urethra. We evaluated the cumulative incidence of intravesical recurrence, progression (muscle-invasive bladder cancer [MIBC] or metastasis), and subsequent radical cystectomy after BCG treatment in patients with UC of the prostatic urethra.</p><p><strong>Results: </strong>The median follow-up period was 57 months (interquartile range, 30-85 months). The exact T stage of the patients with UC of the prostatic urethra was carcinoma in situ (CIS) in 29 (27 in the prostatic urethral mucosa and two in the ductal spread), Ta in 7, Ta + CIS in 2, and T1 in 1. All 39 patients had previous or concurrent bladder cancer. Patients with UC of the prostatic urethra experienced significantly higher rates of intravesical recurrence, progression (MIBC or metastasis), and subsequent radical cystectomy than those without UC of the prostatic urethra. In the multivariate analysis, UC of the prostatic urethra was a significant risk factor for progression (hazard ratio 4.06, 95% confidence interval 1.86-8.86, p < 0.001).</p><p><strong>Conclusions: </strong>This study reported the largest number of clinical outcomes after BCG treatment in patients with UC of the prostatic urethra. Concomitant UC of the prostatic urethra is a strong predictor of subsequent progression; therefore, early timing of radical cystectomy should be discussed.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"71"},"PeriodicalIF":2.8,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Water vapor thermal therapy for treatment of lower urinary tract symptoms due to large benign prostatic hyperplasia (≥ 80 g).","authors":"Christopher Agüero, Thibaut Long Depaquit, Alessandro Uleri, William Berchiche, Renaud Corral, Arthur Peyrottes, Cyrille Bastide, Marc Fourmarier, Michael Baboudjian","doi":"10.1007/s00345-024-05433-z","DOIUrl":"https://doi.org/10.1007/s00345-024-05433-z","url":null,"abstract":"<p><strong>Introduction: </strong>Water vapor thermal therapy (WVTT; REZUM™; Boston, USA) offers symptom relief with reduced risks of complications in patients with lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). WVTT therapy has been validated in the pivotal study in men with smaller prostates (< 80 cc). Yet, its feasibility for larger prostates (≥ 80 cc) remains underexplored.</p><p><strong>Methods: </strong>This retrospective study assessed WVTT efficacy and safety in 131 patients with symptomatic BPH treated between January 2022 and March 2024. Patients were categorized based on prostate size: smaller prostates (SP) (< 80 cc) and larger prostates (LP) (≥ 80 cc). Baseline characteristics, treatment specifics, and post-procedure outcomes-including retreatment rates, symptom scores, and adverse events (AEs)-were recorded. All patients who required surgical retreatment underwent Holmium laser enucleation of the prostate (HoLEP). Statistical analyses compared results between groups over 6- and 12-month follow-up periods.</p><p><strong>Results: </strong>Among the 131 patients, 48 (37%) had LP, with a median volume of 93 cc (Interquartile range (IQR) 88-110). Patients with LP experienced more non-serious AEs, primarily hematuria (p = 0.001), although serious AEs were similar across groups and limited to urinary retention (p = 0.35). At 6 months postoperatively, LP patients had a higher PVR (42 mL(IQR 21-75) vs. 21 mL (IQR2-40); p = 0.032), though this resolved by 12 months. No significant differences were observed between the groups in IPSS, maximum flow rate (Qmax), or erectile function (IIEF-5) scores at either follow-up point. Medical retreatment rates at 12 months were similar (LP: 4% vs. SP: 7%; p = 0.39), as were surgical retreatment rates (LP: 2% vs. SP: 2%; p = 0.51). Ejaculatory function was largely preserved in both groups (LP: 96%, SP: 95%).</p><p><strong>Conclusion: </strong>WVTT therapy in LP is associated with a higher risk of minor post-operative AEs, with similar functional outcomes at one year compared to SP. Longer follow-up studies are needed to compare the durability of treatment in LP.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"69"},"PeriodicalIF":2.8,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In all fields anatomical dissection has improved results - en bloc resection of bladder tumors (ERBT) will make no exception.","authors":"Selcuk Guven, Thomas R W Herrmann","doi":"10.1007/s00345-024-05416-0","DOIUrl":"https://doi.org/10.1007/s00345-024-05416-0","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"70"},"PeriodicalIF":2.8,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The interaction of structured data using openEHR and large Language models for clinical decision support in prostate cancer.","authors":"Philippe Kaiser, Shan Yang, Michael Bach, Christian Breit, Kirsten Mertz, Bram Stieltjes, Jan Ebbing, Christian Wetterauer, Maurice Henkel","doi":"10.1007/s00345-024-05423-1","DOIUrl":"https://doi.org/10.1007/s00345-024-05423-1","url":null,"abstract":"<p><strong>Background: </strong>Multidisciplinary teams (MDTs) are essential for cancer care but are resource-intensive. Decision-making processes within MDTs, while critical, contribute to increased healthcare costs due to the need for specialist time and coordination. The recent emergence of large language models (LLMs) offers the potential to improve the efficiency and accuracy of clinical decision-making processes, potentially reducing costs associated with traditional MDT models.</p><p><strong>Methods: </strong>We conducted a retrospective study of 171 consecutively treated patients with newly diagnosed prostate cancer. Relevant structured clinical data and the European Association of Urology (EAU) pocket guidelines were provided to two LLMs (chatGPT-4, Claude-3-Opus). LLM treatment recommendations were compared to actual treatment recommendations of the MDT meeting (MDM).</p><p><strong>Results: </strong>Both LLMs demonstrated an overall adherence of 93% with the MDT treatment recommendations. Discrepancies between LLM and MDT recommendations were observed in 15 cases (9%), primarily due to lack of clinical information that could be provided to the LLMs. In 5 cases (3%), the LLM recommendations were not in line with EAU guidelines despite having access to all relevant information.</p><p><strong>Conclusions: </strong>Our findings provide evidence that LLMs can provide accurate treatment recommendations for newly diagnosed prostate cancer patients. LLMs have the potential to streamline MDT workflows, enabling specialists to focus on complex cases and patient-centered discussions. In this study, we explored the potential of artificial intelligence models called large language models (LLMs) to assist in treatment decision-making for prostate cancer patients. We found that LLMs, when provided with patient information and clinical guidelines, can recommend treatments that closely match those made by a team of cancer specialists, suggesting that LLMs could help streamline the decision-making process and potentially reduce healthcare costs.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"67"},"PeriodicalIF":2.8,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cranberry prophylaxis in recurrent uncomplicated cystitis - avenues for advancement and clarification.","authors":"Fu-Xiang Lin, Yu-Xiang Zhong, Zhan-Ping Xu","doi":"10.1007/s00345-024-05425-z","DOIUrl":"https://doi.org/10.1007/s00345-024-05425-z","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"68"},"PeriodicalIF":2.8,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of immune checkpoint inhibitors in renal cell carcinoma venous tumour thrombus shrinkage (UroCCR 128).","authors":"Fabien Moinard-Butot, Jonathan Thouvenin, Pierre Bigot, Nieves Martinez-Chanza, Victor Gaillard, Roberto Luigi Cazzato, Romain Boissier, Gaëlle Margue, Philippe Boudier, Denis Maillet, Marine Gross-Goupil, Jean-Christophe Bernhard, Philippe Barthélémy","doi":"10.1007/s00345-024-05428-w","DOIUrl":"10.1007/s00345-024-05428-w","url":null,"abstract":"<p><strong>Purpose: </strong>Surgery remains the cornerstone of localized renal cell carcinoma (RCC) care. Pembrolizumab has recently been recommended as a standard of care for RCC patients who are at high risk of recurrence. Data regarding the efficacy of ICIs either alone or in combination with ICIs or VEGF TKIs for VTT shrinkage are scarce.</p><p><strong>Methods: </strong>In the framework of the French kidney cancer research network UroCCR (NCT03293563), we performed a retrospective multicentric European study to evaluate VTT shrinkage in patients treated with ICIs with metastatic or locally advanced renal cell carcinoma (RCC). The primary endpoint was the objective response rate (ORR) of patients with VTT to ICI-based therapy. Radiological assessment was performed by a treating physician according to the RECISTv1.1 criteria.</p><p><strong>Results: </strong>We included 44 patients. The median age was 69 years (range 37-88). All patients was intermediate or poor IMDC risk group. Twenty-three patients were treated with anti-PD-1 in combination with anti-CTLA-4 therapy, 13 patients with ICI monotherapy, and 8 patients with ICIs in combination with antiangiogenic TKI. At baseline, the median VTT diameter was 22 mm (range 7-93). After a median duration of treatment of 5.8 months (range 1.8-39.1), the ORR was 38% (n = 17), including 4 complete responses (CRs) and 13 partial responses (PRs). Ten patients had stable disease (SD), and 17 had progressive disease (PD) as the best response of the VTT.</p><p><strong>Conclusion: </strong>These data highlight the potential efficacy of ICIs to shrink the VTT even if they seem to have little impact on the extent of VTT.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"66"},"PeriodicalIF":2.8,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11723841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep learning-based lymph node metastasis status predicts prognosis from muscle-invasive bladder cancer histopathology.","authors":"Qingyuan Zheng, Panpan Jiao, Rui Yang, Junjie Fan, Yunxun Liu, Xiangxiang Yang, Jingping Yuan, Zhiyuan Chen, Xiuheng Liu","doi":"10.1007/s00345-025-05440-8","DOIUrl":"10.1007/s00345-025-05440-8","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a deep learning (DL) model based on primary tumor tissue to predict the lymph node metastasis (LNM) status of muscle invasive bladder cancer (MIBC), while validating the prognostic value of the predicted aiN score in MIBC patients.</p><p><strong>Methods: </strong>A total of 323 patients from The Cancer Genome Atlas (TCGA) were used as the training and internal validation set, with image features extracted using a visual encoder called UNI. We investigated the ability to predict LNM status while assessing the prognostic value of aiN score. External validation was conducted on 139 patients from Renmin Hospital of Wuhan University (RHWU; Wuhan, China).</p><p><strong>Results: </strong>The DL model achieved area under the receiver operating characteristic curves of 0.79 (95% confidence interval [CI], 0.69-0.88) in the internal validation set for predicting LNM status, and 0.72 (95% CI, 0.68-0.75) in the external validation set. In multivariable Cox analysis, the model-predicted aiN score emerged as an independent predictor of survival for MIBC patients, with a hazard ratio of 1.608 (95% CI, 1.128-2.291; p = 0.008) in the TCGA cohort and 2.746 (95% CI, 1.486-5.076; p < 0.001) in the RHWU cohort. Additionally, the aiN score maintained prognostic value across different subgroups.</p><p><strong>Conclusion: </strong>In this study, DL-based image analysis showed promising results by directly extracting relevant prognostic information from H&E-stained histology to predict the LNM status of MIBC patients. It might be used for personalized management of MIBC patients following prospective validation in the future.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"65"},"PeriodicalIF":2.8,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technological innovation of HoLEP: a multicenter, randomized, controlled study for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia.","authors":"Zhixiang Gao, Ping Wang, Haiyong Liu, Yue Ding, Li Xu, Zhiwei Sun, Renji Du, Lijuan Gu, Yajun Shen, Rong Wang","doi":"10.1007/s00345-024-05438-8","DOIUrl":"10.1007/s00345-024-05438-8","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to investigate the efficacy of Transurethral Holmium Laser of the Prostate (HoLEP) with Double-n Technology in the treatment of benign prostatic hyperplasia (BPH), with a focus on preserving sexual function postoperatively.</p><p><strong>Methods: </strong>Conducted as a multicenter, prospective, single-blind randomized controlled trial, this study enrolled sexually active male patients with BPH. Participants were randomized into three groups: standard HoLEP (Group A), single-n technology (Group B), and innovative double-n technology (Group C), which emphasizes the preservation of the urethral mucosa and nearby structures. The primary endpoints included maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF).</p><p><strong>Results: </strong>Of the 180 initial participants, 139 completed the study. All groups showed significant improvements in Qmax and IPSS. Initial declines in IIEF scores were noted across all groups, stabilizing to baseline by 3 months without further improvement. Group A had modest antegrade ejaculation rates, starting at 15.4% at 3 months and reaching 23.1% at 12 months. Group B showed a significant improvement, with AE rates rising from 31.8% at 3 months to 45.5% at 12 months, significantly higher than Group A (p < 0.05). Group C had the highest AE rates, starting at 57.8% at 3 months and reaching 77.8% at 12 months, significantly surpassing both Group A and B (p < 0.05). Regarding semen reduction, Group A had 100% reduction at 3 months, which decreased to 77.8% at 12 months. Group B followed a similar trend, from 100% at 3 months to 68.2% at 12 months. Group C showed a more pronounced decline, starting at 84.6% at 3 months and dropping to 37.1% at 12 months, with values significantly lower than both Groups A and B (p < 0.05).</p><p><strong>Conclusions: </strong>The double-n HoLEP technique shows promising results in improving urinary symptoms while better preserving ejaculatory function and sexual quality of life in BPH patients. This technique could offer a significant advancement in the surgical management of BPH, particularly for sexually active patients.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"64"},"PeriodicalIF":2.8,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}