Journal of Minimal Access Surgery最新文献

{"title":"Outcomes of laparoscopic single-incision caecal pole resection for low-grade appendiceal mucinous neoplasm.","authors":"Han Deok Kwak","doi":"10.4103/jmas.jmas_113_23","DOIUrl":"10.4103/jmas.jmas_113_23","url":null,"abstract":"<p><strong>Introduction: </strong>Low-grade appendiceal mucinous neoplasm (LAMN) is a rare disease, and its clinical course varies from an incidental finding without symptoms to pseudomyxoma peritonei. Furthermore, there are few established treatment guidelines. This study was designed to confirm the outcomes in patients diagnosed with LAMN who underwent single-incision laparoscopic caecal pole resection.</p><p><strong>Patients and methods: </strong>This study was conducted on pathologically confirmed LAMNs from patients who underwent surgery at a single centre, a tertiary institution, from July 2016 to August 2022. Patients diagnosed with LAMN as a result of biopsy were included. All surgeries were performed with single-incision laparoscopic caecal pole resection by a single surgeon.</p><p><strong>Results: </strong>A total of 70 patients were included. The median age was 65.5 years and 36 (51.4%) patients were female. The baseline carcinoembryonic antigen (CEA) was 8.08 ng/mL (0.76-148.11). The mean maximum diameter was 29.4 mm (7-70) and calcification was seen in 22 cases on pre-operative computed tomography (CT). As a result of histological examination, all patients were marginally negative. The larger the tumour size, the higher the CEA was ( P = 0.011), and it was often accompanied by calcification ( P = 0.021). In addition, tumour size and CEA showed a positive partial correlation with each other ( r = 0.318, P = 0.018). The overall median follow-up period was 22.7 months (2-60). One case had suspected of recurrence on CT scan performed at 33 months following the surgery, but there were no related symptoms.</p><p><strong>Conclusion: </strong>Single-port laparoscopic caecal pole resection without margin involvement in LAMN was safe and feasible, and showed a favourable long-term outcome.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"107-111"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12054950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41240105","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":"Multidetector computed tomography evaluation of normal thymus and variations with age.","authors":"Suprava Naik, Aishvarya Shri, Simran Sidhu, Yuvraj Lahre, Nerbadyswari Deep Bag, Sanjeev Kumar Bhoi, Sudipta Mohakud","doi":"10.4103/jmas.jmas_25_23","DOIUrl":"10.4103/jmas.jmas_25_23","url":null,"abstract":"<p><strong>Background: </strong>Thymus is a T-cell-producing lymphoid organ that appears prominent in the paediatric population and involutes in size with ageing. The gland shows a wide variety of appearances across different age groups. The purpose of the study is to evaluate the computed tomography (CT) appearance of thymus gland in the normal population with a focus on size, CT attenuation and fatty infiltration in different age groups.</p><p><strong>Patients and methods: </strong>This is a retrospective study done after taking approval from the Institutional Ethics Committee. Patients undergone CT scans of the thorax were identified from our database. All evaluations were done in non-contrast CT scans. Patients having underlying diseases that may have associated thymic abnormality were excluded. The appearance of thymus and the presence of fatty replacement were assessed. The size of thymus (length and thickness of right limb and left limb) and non-contrast CT Hounsfield unit (HU) value of thymic tissue were measured and compared in various age groups.</p><p><strong>Results: </strong>Four hundred and fifty patients were included, 262 (58.2%) were male. Mean age was 33.6 ± 17.1 years, range (3 months-80 years). The size of thymus was observed to decrease with increasing age. The mean age of complete fatty replacement in our study was 45 years. Complete fatty replacement was noted in all cases with an age of more than 60 years. The most common shape was arrowhead, and the most common location was pre-aortic and para-aortic location. Non-contrast CT HU value was maximum in infants and gradually decreased with advancing age.</p><p><strong>Conclusion: </strong>Even normal thymus can show varied appearance on CT which changes with the age of the patient being imaged. A comparison with normative data could help differentiate normal from abnormal glands to avoid unnecessary intervention.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"101-106"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12054957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10232052","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":"Preliminary comparative outcomes of Versius Robotic System-assisted cholecystectomy and laparoscopic cholecystectomy for benign gall bladder disease: Retrospective single-centre, single-surgeon analysis.","authors":"Muharrem Oner","doi":"10.4103/jmas.jmas_13_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_13_24","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to compare the outcomes of Versius Robotic System-assisted cholecystectomy with conventional laparoscopic cholecystectomy for benign gall bladder pathologies, focusing on the perioperative and post-operative parameters.</p><p><strong>Patients and methods: </strong>A retrospective study was conducted on patients with Versius Robotic System-assisted (Group VRS) or conventional laparoscopic cholecystectomy (Group LAP) between September 2021 and June 2023. Patient demographics, perioperative (operative time, conversion and intraoperative complications) details, post-operative pain management and complications were analysed.</p><p><strong>Results: </strong>The study included 44 and 58 patients in Groups VRS and LAP. In Group VRS, we detected significantly reduced post-operative pain (P = 0.009), lower opioid use (P = 0.009) and shorter hospital stays (P = 0.029) than in Group LAP. Total operative time was longer in Group VRS (P < 0.001). No intraoperative complications or conversions occurred in either group.</p><p><strong>Conclusion: </strong>Versius Robotic System-assisted cholecystectomy is a safe and feasible approach for benign gall bladder pathologies, offering benefits such as reduced post-operative pain and shorter hospital stays.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711793","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":"Demographic and clinical predictors of bariatric surgery patients: A retrospective cohort study.","authors":"Raghad Abdulmohsen Aljuhani, Fatma Elsayed Hassan, Zainab Jasim AlQurain, Tanveer Nidal Khan, Doaa A Turkistani, Mohammed Ahmed Alabbadi","doi":"10.4103/jmas.jmas_377_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_377_24","url":null,"abstract":"<p><strong>Introduction: </strong>The significant rise in bariatric procedures (BPs) reflects the global increase in obesity. In Saudi Arabia, obesity prevalence is notably high at 35.6%, surpassing the global average. This retrospective cohort study primarily aims to identify demographic and clinical predictors influencing BP uptake among individuals at a single healthcare centre in Jeddah, Saudi Arabia. Secondarily, it evaluates the effectiveness of BPs, particularly laparoscopic sleeve gastrectomy (LSG), in reducing body mass index (BMI) and obesity-related comorbidities.</p><p><strong>Patients and methods: </strong>Data were extracted from the hospital's registry between October 2023 and June 2024. The study population included obese adults of varying ages, genders and comorbidities who underwent bariatric surgery. However, the single-centre design limited generalisability, long-term outcome data were unavailable and contextual factors, such as socioeconomic status and health literacy, were not captured.</p><p><strong>Results: </strong>A cohort of 208 patients was analysed, 64.9% females and 34.2% males, with a mean age of 36 ± 11.2 years. The pre-operative BMI was 44.10 ± 6.2 kg/m² (P = 0.462), which decreased to 35.1 ± 6.5 kg/m² (P = 0.577) postoperatively, reflecting a mean reduction of 9.03 ± 4.9 kg/m² (20.5%) (P = 0.255). LSG was the most performed BP at 93.3%. The most prevalent obesity-related comorbidities identified were hypertension, diabetes and GIT disease including gall bladder disorders (15.9%, 13.9% and 13.5%, respectively).</p><p><strong>Conclusions: </strong>This study highlights the increasing prevalence of BP, particularly among young, predominantly female patients. LSG demonstrated substantial effectiveness, achieving a 20.5% reduction in BMI and improvement in obesity-related comorbidities. Future research could explore more patient demographics that could not be analysed in this study.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694216","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":"Robot-assisted lateral pancreaticojejunostomy in a patient with chronic pancreatitis and history of liver transplantation.","authors":"Boštjan Plešnik, Jan Grosek, Blaž Trotovšek, Aleš Tomažic, Miha Petric","doi":"10.4103/jmas.jmas_347_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_347_24","url":null,"abstract":"<p><strong>Abstract: </strong>A 52-year-old female patient with a history of liver transplantation due to alcoholic liver cirrhosis presented with persistent post-prandial pain, leading to substantial weight loss of 16 kg. The findings of contrast-enhanced computed tomography were consistent with the diagnosis of chronic pancreatitis, and endoscopic treatment provided no functional improvement. The patient was scheduled for a robot-assisted lateral pancreaticojejunostomy which was performed after initial lysis of adhesions from her prior liver transplantation. The procedure was completed safely using the robotic da Vinci Xi platform in 180 min, with an estimated blood loss of 300 mL. During the post-operative course, anaemia was noted and treated with a blood transfusion, and the patient was discharged on the post-operative day 4. The patient fully recovered without post-prandial pain and began regaining weight 1 month after the procedure. To the best of our knowledge, this is the first report of a successful robot-assisted lateral pancreaticojejunostomy following prior liver transplantation.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694143","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":"Comparative evaluation of enhanced total extraperitoneal repair and intraperitoneal onlay mesh repair-plus for ventral hernias: A randomised controlled study.","authors":"Shikha Singh, Himanshu Agrawal, Aditya Kumar, Nitin Agarwal, Nikhil Gupta","doi":"10.4103/jmas.jmas_379_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_379_24","url":null,"abstract":"<p><strong>Introduction: </strong>Ventral hernia repair techniques have evolved, with enhanced total extraperitoneal repair (eTEP) and intraperitoneal onlay mesh repair-plus (IPOM+) emerging as alternatives. While eTEP avoids complications such as adhesions and infections associated with intraperitoneal mesh placement, its effectiveness compared to IPOM+ remains debated. To compare the outcomes of eTEP and IPOM+ in primary midline ventral hernia repair, focusing on post-operative pain, complications and early recurrence rates.</p><p><strong>Patients and methods: </strong>A randomised controlled study was conducted in a tertiary hospital in Delhi from August 2022 to February 2024. Forty-eight patients with primary midline ventral hernias (defect size: 2-6 cm) were randomised into eTEP (n = 24) and IPOM+ (n = 24) groups. Outcomes included operative time, pain scores (evaluated at 6 h, 24 h, 7 days, 1 month and 3 months), analgesic use, complications (seroma and surgical site infections) and recurrence rates.</p><p><strong>Results: </strong>eTEP had significantly longer operative time (115.83 ± 36.30 min vs. 63.94 ± 10.94 min; P < 0.001) but significantly lower pain scores at 6 and 24 h (P < 0.001). Analgesic requirements were reduced in the eTEP group, with only two patients requiring rescue analgesia compared to 20 in the IPOM+ group (P < 0.001). No significant differences were observed in seroma rates, surgical site infections or recurrence at 3 months.</p><p><strong>Conclusions: </strong>eTEP offers reduced early post-operative pain and lower analgesic use compared to IPOM+, with similar complication and recurrence rates. Despite longer operative times, eTEP provides a viable alternative for ventral hernia repair with potential quality-of-life benefits.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694213","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":"Osteitis pubis after laparoscopic totally extraperitoneal inguinal hernia repair: An uncommon complication - Report of two cases.","authors":"Sanjay Marwah, Mahavir Singh, Deepanshu Lather, Ritesh Kumar","doi":"10.4103/jmas.jmas_259_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_259_24","url":null,"abstract":"<p><strong>Abstract: </strong>Osteitis pubis is a well-known complication of urologic and gynecologic procedures but its association with hernioplasty is poorly documented in the literature. We are reporting two cases of osteitis pubis following laparoscopic hernia repair. In first case, a 52-year-old man underwent bilateral totally extra-peritoneal repair (TEP) for bilateral inguinal hernia. Mesh fixation was done with metallic (titanium) tackers at iliopubic tract. Two weeks later he complained of sharp stabbing pain in the pubic area and dull aching pain on inner aspect of right thigh more during abduction and extension of hip joint. There was no associated fever or local signs of acute inflammation. Roentgenogram and MRI showed changes typical of osteitis pubis. There was no evidence of infection in the urinary tract or elsewhere. The patient was managed conservatively with analgesics and physiotherapy. Patient recovered well. In second case, a 40-years-old male underwent bilateral totally extra-peritoneal repair (TEP) for bilateral inguinal hernia with mesh fixation with metallic tackers at iliopubic tract. After 20 days of surgery patient developed pain on medial aspect of thigh which was exaggerated on extension and abduction at hip joint. Again, Roentgenogram and MRI showed changes typical of osteitis pubis. This patient was also managed conservatively on same line as previous case.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694140","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":"Laparoscopic treatment of a Nuck cyst with an inguinal hernia.","authors":"Carlos Alfredo Mares, Salvador Cristobal De Las Casas, Maria Valeria Vega, Wilfredo Bozzo","doi":"10.4103/jmas.jmas_389_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_389_24","url":null,"abstract":"<p><strong>Abstract: </strong>Nuck's canal cysts are rare surgical embryological anomalies primarily observed in females under 5 years of age. They occur due to a failure of the processus vaginalis to completely obliterate, a process that should be complete within the first year of life. Clinically, these cysts manifest as a mass in the inguinal region or labia majora, which may or may not be associated with pain. This report presents the case of a 29-year-old female patient who presented with a painful mass in the right inguinal region. An abdominal wall ultrasound and magnetic resonance imaging revealed a right inguinal cystic lesion. A diagnostic and therapeutic laparoscopy was performed and revealed a cystic tumour adjacent to the round ligament. The tumour was treated through a transabdominal preperitoneal approach. The patient was discharged without complications and experienced no complications during subsequent follow-ups.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694223","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":"Single-stage robot-assisted repair of symptomatic inguinal and Morgagni hernias in an adult male.","authors":"Sydney C Bertram, Savannah H Skidmore, Daniel Akyeampong, Mike M Mallah, Stephen A Fann","doi":"10.4103/jmas.jmas_281_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_281_24","url":null,"abstract":"<p><strong>Abstract: </strong>While laparoscopic and robotic repair of diaphragmatic hernias has recently become commonplace, minimally invasive single-stage procedures combining diaphragmatic hernia repair with another procedure remain rare. Our patient is a 61-year-old male presenting with a left-sided inguinal bulge and later dyspnoea, found to have concomitant left inguinal hernia and Morgagni-type diaphragmatic hernia. The patient was taken to the operating room for simultaneous robotic repair of both hernias. The procedure was completed robotically using two different docking orientations with the same three 8-mm port sites. The inguinal hernia was repaired using a standard transabdominal preperitoneal approach, and the Morgagni hernia was repaired primarily and reinforced with porcine biologic mesh. The procedure was without complication and the patient's symptoms resolved. We infer from our experience that simultaneous robotic repair of multiple hernia types is feasible and may decrease patient anaesthesia episodes as well as surgeon fatigue associated with laparoscopic and open approaches.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694242","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":"From flab to fab: A cross-sectional study for cultural adaptation and validation of the Fat Phobia Scale-Short Form in India.","authors":"Kumari Rina, Rosali Bhoi, Anubhav Vindal, Pawanindra Lal","doi":"10.4103/jmas.jmas_271_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_271_24","url":null,"abstract":"<p><strong>Background: </strong>Due to the lack of a validated instrument to measure fatphobia, its epidemiology in India remains unknown. This study aimed to culturally adapt and validate the Fat Phobia Scale-Short Form (FPS-SF) in Hindi.</p><p><strong>Patients and methods: </strong>A cross-sectional study using a purposive sampling technique was conducted in the metabolic surgery clinic of a tertiary care teaching institution. We followed the World Health Organization's procedure for cultural adaptation and validation of an instrument. The study was biphasic. The phase-1 entailed forward translation, formation of an expert panel, backward translation and cognitive interviewing with the two groups of seven individuals, each with severe obesity. During phase-2, 175 participants (students [n = 120], patients [n = 55]) were recruited after written informed consent. Hindi-FPS-SF was administered to students twice, 1 week apart. All participants completed Hindi-FPS-SF, Modified Weight Bias Internalization Scale (Hindi-WBIS-M), Patient Health Questionnaire (Hindi-PHQ-9) and Generalised Anxiety Disorder Questionnaire (Hindi-GAD-7). Statistical analysis was done.</p><p><strong>Results: </strong>Several items of forward-translated Hindi-FPS-SF underwent culture-specific modifications in Phase-1. Content or curricular validity and face validity were assessed. In Phase-2, the reliability and validity of Hindi-FPS-SF were evaluated. The internal consistency (Cronbach's alpha), intra-class correlation type-A coefficient (ICC) and cross-cultural reliability were α =0.902 (P < 0.001), 0.799 (95% CI = 0.753-0.840) (P < 0.001) and (ICC: 0.865-0.992) (P < 0.001), respectively. The convergent-construct validity assessed by correlations between total scores of Hindi-WBIS-M and Hindi-FPS-SF was significant. Criterion validity measured through correlations with original FPS-SF, Hindi-WBIS-M, PHQ-9 and GAD-7 was significant.</p><p><strong>Conclusions: </strong>The Hindi-FPS-SF demonstrated good psychometric properties and may be used to measure fat phobia and its correlates in India for epidemiological purposes.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694220","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}