GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW最新文献

{"title":"Free vascularized fibula transfer in single- or double-barrel technique for reconstruction of segmental bone defects following oncological resection or posttraumatic bone loss.","authors":"Kevin Bienger, Vlad Stefan, Adrian Dragu, Olimpiu Bota, Feras Taqatqeh, Klaus-Dieter Schaser, Michele Rudari, Hagen Fritzsche","doi":"10.3205/iprs000189","DOIUrl":"10.3205/iprs000189","url":null,"abstract":"<p><strong>Background: </strong>Significant osseous defects or osteonecrosis, precipitated by open fractures, infections, or neoplastic conditions, represent infrequent yet critical medical conditions. The free vascularized fibular graft (FVFG) is a challenging but straightforward, reliable surgical intervention for the reconstruction of defects across various anatomical regions. This study aims to compare, quantify, and demonstrate the FVFG's versatility. The utilization of a single- or double-barrel approach, contingent on the defect's characteristics, optimizes length conservation or enhances the stability of extensive defects.</p><p><strong>Methods: </strong>We retrospectively evaluated patients who underwent the FVFG procedure, employing either a single- or double-barrel technique, at our medical center during the period from August 2017 to May 2023. The inclusion criterion was the presence of substantial osseous defects (bone loss in straight bone over 8-10 cm or multi-level spine resection), precipitated by trauma, neoplasms, non-union fractures or infections.</p><p><strong>Results: </strong>Our study encompassed eight male patients, with an average age of 31 years, ranging from 10 to 56. Each patient underwent osseous resection due to osteomyelitis (n=2), tumor excision (n=4), or pseudarthrosis (n=2) resulting from previous trauma, followed by a free fibula flap as part of the FVFG procedure. When fibula was simultaneously prepared already during tumor resection (n=2), there was a significant reduction in the overall operation time. Postoperative assessment revealed that full osseous integrity without any graft failure was restored in all patients, and the same number of patients regained independent ambulatory ability. Surgical complications were observed in one patient, who exhibited wound healing post-reconstruction, all of which were rectified through subsequent surgical intervention.</p><p><strong>Conclusion: </strong>Diverse osseous defects in complex cases can be reconstructed by using the FVFG, thereby restoring maximal reconstructive capacity, expedited union compared to non-vascularized bone, and acceptable donor site morbidity. FVFG remain a reliable solution for diverse defects. Moreover, in cases requiring complex tumor defects, careful preoperative planning and an interdisciplinary treatment are essential for successful treatment.</p>","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":"13 ","pages":"Doc07"},"PeriodicalIF":1.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985014","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":"Patient satisfaction after miraDry^® treatment for axillary hyperhidrosis. Results of an online patient survey after miraDry^® treatment to reduce excessive axillary sweating.","authors":"Ursula Tanzella, Klaus Ueberreiter, Armin Bell, Moritz A Krapohl, Björn Dirk Krapohl","doi":"10.3205/iprs000188","DOIUrl":"10.3205/iprs000188","url":null,"abstract":"<p><p>Hyperhidrosis, with a prevalence of 1 to 2% of the population, primarily affects young people under 40 years of age. The individually perceived burden of odor and amount of sweat leads to a reduced quality of life. In recent years, conservative and surgical measures have been used to treat hyperhidrosis. The miraDry^® method based on microwave technology is a non-invasive treatment that enables comparable results in terms of effectiveness while at the same time reducing the burden. In the Park-Klinik Birkenwerder, 282 hyperhidrosis patients were treated with the miraDry^® method between 2017 and 2024. An online survey was conducted in May and June 2024. 220 patients were contacted, the results of 80 patients are available (response rate: 36.4%). Changes in the restrictions caused by increased sweating in various areas of life were asked before and after the treatment. In addition, the assessment of general quality of life before and after the treatment was compared. There is a significant reduction in restrictions and a corresponding increase in quality of life after treatment with miraDry^®. Satisfaction with the method is high, which is reflected in a high recommendation rate of over 80%.</p>","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":"13 ","pages":"Doc06"},"PeriodicalIF":1.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11570828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669576","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":"Scalp reconstruction with locoregional and free flaps - a retrospective cohort study.","authors":"Olimpiu Bota, Franziska Beyer, Johann Klein, Tareq A Juratli, Adrian Dragu, Kevin Bienger","doi":"10.3205/iprs000187","DOIUrl":"10.3205/iprs000187","url":null,"abstract":"<p><strong>Introduction: </strong>Scalp defect reconstruction requires interdisciplinary cooperation to restore soft tissue and osseous defects. While wound closure and form restoration, often a short-term treatment goal, ensures patient survival, the long-term preservation of the head and neck's integrity and aesthetics is crucial for maintaining quality of life. This study aims to compare, quantify, and establish a safe and reproducible approach to various reconstruction options and the postoperative complication profile for individual scalp defect areas.</p><p><strong>Materials and methods: </strong>We retrospectively evaluated patients who underwent scalp reconstruction at our institution between March 2017 and April 2022. The inclusion criterion was the presence of a soft tissue defect at the cranium level.</p><p><strong>Results: </strong>We included 31 patients in the study (17 males, 14 females), with an average age of 61 years (range 17-92 years). Eight patients had received radiotherapy in the affected region. The mean defect size was 72.5±116 cm² (range 20-441 cm²), and an average of 3±2 surgeries had been performed before the plastic surgical treatment was initiated. Eleven patients had only a soft tissue defect, while 20 patients had an associated bone defect. Fifteen of these patients received a cranioplasty. The rotation flap was the most frequently used (n=23), with or without split-thickness skin grafting, followed by the free latissimus dorsi muscle flap with split-thickness skin grafting (n=5), and the free lateral arm flap (n=2). Revision surgeries were necessary in 38.7% of cases due to wound healing disorders (n=9), bleeding (n=2), and cerebrospinal fluid leaks (n=1). Eventually, all wounds were successfully closed.</p><p><strong>Conclusion: </strong>Complex scalp defects can be closed using local flaps, thereby restoring aesthetics and tissue integrity. Free flaps remain a reliable solution for extensive defects. Moreover, in cases requiring cranioplasty, careful preoperative planning and an uncontaminated wound are essential for successful treatment.</p>","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":"13 ","pages":"Doc05"},"PeriodicalIF":1.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11463031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394123","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":"Results of a patient survey using an online questionnaire after implant removal for breast implant illness.","authors":"Ursula Tanzella, Klaus Ueberreiter, Lola Fanny Krapohl, Armin Bell, Björn Dirk Krapohl","doi":"10.3205/iprs000186","DOIUrl":"https://doi.org/10.3205/iprs000186","url":null,"abstract":"<p><p>The use of silicone breast implants has a history of over 60 years. In recent years, specific health issues among implant wearers have repeatedly come into focus. The term \"breast implant illness\" has been circulating in scientific literature and on social media for several years. It describes a cluster of up to 60 different symptoms. The present results of an online survey conducted within a clinic's patient population of the last 8 years show, among other things, the evolution of 8 reported symptoms before and after breast implant removal. In the comparison before and after, there is a significant reduction in the intensity of symptoms after implant removal. A causal relationship with the removal of the implants is to be presumed.</p>","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":"13 ","pages":"Doc04"},"PeriodicalIF":0.4,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11036085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859066","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":"Acral melanoma of the heel mimicking a pressure sore.","authors":"Matthias Fischer, Anita Sünkenberg, Reem Ali Deeb, Björn Dirk Krapohl","doi":"10.3205/iprs000185","DOIUrl":"https://doi.org/10.3205/iprs000185","url":null,"abstract":"<p><strong>Background: </strong>The clinical appearance of acral melanoma is diverse and can cause diagnostic difficulties in individual cases.</p><p><strong>Case description: </strong>We present a clinical case of an 83-year-old patient with a melanoma in the heel area that was initially interpreted as a pressure ulcer, resulting in delayed and more complicated treatment.</p><p><strong>Conclusions: </strong>Melanomas should be included in the differential diagnosis even in \"typical\" pressure ulcer areas. Against the background of increasingly poor healthcare in rural areas, an increase in such cases can be expected.</p>","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":"13 ","pages":"Doc03"},"PeriodicalIF":0.4,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11036084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871728","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":"Intramedullary arthrodesis of the knee joint with additional femoral neck screw to prevent periprosthetic fracture of the proximal femur. A case report.","authors":"Mohamed Ghanem, Christina Pempe, Andreas Roth","doi":"10.3205/iprs000184","DOIUrl":"10.3205/iprs000184","url":null,"abstract":"<p><p>Arthrodesis of the knee joint has proven effective in the treatment of chronic periprosthetic infections as well as in cases of previous multiple revision surgery after total knee replacement with insufficiency of the extensor apparatus. In this case report, we report on the use of a custom-made intramedullary arthrodesis nail of the knee joint following multiple revisions due to aseptic loosening after total knee replacement. Surgery was performed according to preoperative computerized planning. Microbiological and histological samples obtained intraoperatively showed no evidence of infection. Yet, the patient presented postoperatively with complete loss of active dorsiflexion of the ipsilateral foot. On one-year follow-up, the patient did not complain of any pain. The radiological findings one year after surgery showed no sign of loosening or any other pathological findings. The neurological lesion has completely recovered. The Harris Hip Score HHS improved from 24 (prior to implantation of the arthrodesis) to 75 on one-year follow-up, the Western Ontario and McMaster Universities Osteoarthritis Index WOMAC improved from 86 to 20. The particularity of this case lies in the fact that an additional femoral neck screw was brought in to prevent periprosthetic fracture of the proximal femur. Careful preoperative planning as well as surgical performance were necessary to adjust the rotation of the femoral nail to allow adequate positioning of the femoral neck screw. Intramedullary arthrodesis of the knee is a suitable management option following multiple revision surgery after total knee replacement with insufficiency of the extensor apparatus. In many cases, an individual therapeutic plan is necessary ranging up to the use of custom-made implants.</p>","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":"13 ","pages":"Doc02"},"PeriodicalIF":0.4,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10963901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307240","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":"Subtotal diaphyseal replacement of the femur with modular mega-endoprosthesis following interprosthetic fracture. A case report.","authors":"Mohamed Ghanem, Christina Pempe, Andreas Roth","doi":"10.3205/iprs000183","DOIUrl":"10.3205/iprs000183","url":null,"abstract":"<p><p>Mega-endoprostheses enable wide management options in the treatment of primary and periprosthetic fracture of the lower extremities. In this study, we report on the use of custom-made subtotal diaphyseal endoprosthetic replacement in treatment of interprosthetic femoral fracture. This procedure is off-label, but in this particular case, it was the safest and most stress-stable treatment option. The implant was delivered within three weeks. The surgical procedure for subtotal replacement of the femoral diaphysis was performed without any intra- or postoperative complication. The duration for the surgical intervention was one hour and 40 minutes. The patient was then mobilized with full weight bearing. At one-year follow-up, the patient did not complain of any pain. The Harris Hip Score HHS improved from 26 to 83 at one-year follow-up, the Western Ontario and McMaster Universities Osteoarthritis Index WOMAC improved from 88 to 16. Mega-endoprostheses enable a wide range of management options in the treatment of primary, peri- and interprosthetic fractures of the lower extremities. In many cases, an individual therapeutic plan is necessary ranging up to the use of custom-made implants.</p>","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":"13 ","pages":"Doc01"},"PeriodicalIF":0.4,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10963900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140308493","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":"Mandibular symmetry on posterior-anterior cephalograms of neurofibromatosis type 1 patients with facial plexiform neurofibroma.","authors":"Reinhard E Friedrich, Georg Christ, Hanna A Scheuer","doi":"10.3205/iprs000181","DOIUrl":"https://doi.org/10.3205/iprs000181","url":null,"abstract":"<p><strong>Introduction: </strong>Neurofibromatosis type 1 (NF1) is an is an autosomal dominant heritable tumor predisposition syndrome.. Peripheral nerve sheath tumors (PNST) are a hallmark of NF1. Plexiform neurofibromas (PNF) are neoplasms that are characteristic of NF1, often causing disfiguring effects (e.g., on the face), and are considered precancerous lesions. Previous studies have shown that facial PNF (FPNF) have an impact on the shape of facial bones. This study examines deviations of mandibular symmetry from cephalometric reference planes considering the topography of FPNF.</p><p><strong>Material and methods: </strong>The posterior-anterior (PA) cephalograms of 168 patients with NF1 were examined. We compared three groups: patients with FPNF (n=74), with disseminated cutaneous neurofibroma (DNF (n=94)), and control subjects without NF1 (n=23). The PNF group was subtyped with respect to facial PNST type and location. Typical mandibular cephalometric reference points were determined (condyle, antegonion, and menton).</p><p><strong>Results: </strong>The skeletal measurement points of the mandible in FPNF patients often differ significantly from those of the DNF group. It has been proven that typical asymmetries of the median-sagittal measurement points are indicators of PNF. Differences within the trigeminal tumor spread patterns are indicated in the measured values. A local tumor effect (PNF) on the relation of the measurement points to the reference planes is made plausible by the study results. The investigations prove that tumor type (FPNF) and the number of FPNF affected branches of the trigeminal nerve may correlate with significant deviations of mandible from symmetry on PA projections.</p><p><strong>Conclusion: </strong>The presented study shows that characteristic patterns of mandibular deformity can be measured on standardized radiographs in NF1 patients with FPNF. Mandibular deformities imaged on standardized radiographs may be initial indicators of a previously unrecognized NF1. Tumor-associated alterations of the mandible should be considered in the classification systems of pathognomonic, diagnostically pioneering osseous findings in NF1. The radiological findings provide clues for planning mandibular osteotomies in NF1 patients, especially for assessing facial regions typically highly vascularized by tumor spread. Furthermore, the radiological findings are an indication of a tumor potentially invading and destroying adjacent masticatory and mimic muscle, findings that may have an influence on surgical measures (function, aesthetics, and wound healing).</p>","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":"12 ","pages":"Doc11"},"PeriodicalIF":0.4,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10726724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138811124","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":"Fournier gangrene - would you KISS it?","authors":"Miguel João Ribeiro Matias, Diogo Guimarães, Manuel Vilela, Juliana Sousa, Joaquim Bexiga","doi":"10.3205/iprs000182","DOIUrl":"https://doi.org/10.3205/iprs000182","url":null,"abstract":"<p><p>Fournier gangrene is a disease characterized by necrotizing fasciitis of the perineal and genital region, resulting from synergistic polymicrobiotic infection. Most infections can be localized to a cutaneous, urethral, or rectal source and can culminate in a fulminant sepsis. Current state of the art is systemic broad-spectrum antibiotics and serial aggressive debridement which result in superficial perineal defect of wide dimensions. We compiled all the cases of Fournier gangrene that required reconstruction after debridement in Centro Hospitalar Universitário Lisboa Central from 2018 to 2022. Inclusion criteria were reconstruction for Fournier defects and patients' age 18 to 90 years old. Exclusion criteria were patients who didn't require reconstruction or didn't complete it due to death or transfer to another healthcare institution. Reconstructive procedures and complication rates are reported as whole numbers and percentages of total. The initial search yielded 32 patients. There were 2 (6.2%) patients with defects that healed by secondary intention, 6 (18.7%) with delayed primary closure, 4 (12.5%) with implantation of the testicle in a medial thigh pocket, 12 (37.5%) with skin grafts, 4 (12.5%) with scrotal advancement flaps, 2 (6.2%) with flaps, and 2 (6.2%) with flaps and skin grafts in combination. Four outcomes were evaluated: number of patients, defect size, method of reconstruction, and wound-healing complications. Most reconstructive techniques provide reliable coverage and protection of testicular function with an acceptable cosmetic result. The reconstructive options need to be patient tailored in order to achieve long lasting results with a minimum of postoperative morbidity.</p>","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":"12 ","pages":"Doc12"},"PeriodicalIF":0.4,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10726960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138811120","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":"Current standards in the diagnosis and treatment of oral squamous cell carcinoma - a multicenter analysis.","authors":"Karsten Schreder, Oliver Thiele, Alexander Eckert","doi":"10.3205/iprs000180","DOIUrl":"https://doi.org/10.3205/iprs000180","url":null,"abstract":"<p><p>The German guideline for oral squamous cell carcinoma (OSCC) describes the recommended diagnosis and treatment procedures for OSCC and ensures the highest quality patient care. However, the current German guideline for OSCC is indistinct and therapy planning is not standardized in detail between centers. To address this, the current diagnostic and therapeutic strategies in different oral and maxillofacial surgery departments in Germany were summarized using a uniform questionnaire. The results revealed high standards in oncologic maxillofacial care, but non-uniform standards exist between centers. Moreover, an increasing use of diagnostic and treatment methods that are not included in the German guideline for OSCC, such as positron emission tomography computed tomography (PET-CT) and tumor biomarkers, were used by different centers. These results support the updated German guideline for OSCC but highlight the need to consider other additive methods to improve patient care and outcomes. Furthermore, a recommendation to introduce tumor passports to simplify OSCC diagnosis and treatment should be discussed. These changes will improve the prognosis and quality of life of patients with OSCC.</p>","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":"12 ","pages":"Doc10"},"PeriodicalIF":0.4,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10666175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138463374","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}