Neurologist最新文献

{"title":"Acute Spinal Cord Infarct Secondary to Fibrocartilaginous Embolism Treated With Tenecteplase.","authors":"Jenica Patel, Prasuna Kamireddi, Sneha Jacob","doi":"10.1097/NRL.0000000000000666","DOIUrl":"10.1097/NRL.0000000000000666","url":null,"abstract":"<p><strong>Introduction: </strong>Fibrocartilaginous embolism is a rare cause of spinal cord infarction. It can affect young healthy adults during physical exertion or the Valsalva maneuver. There is little evidence behind a fibrocartilaginous embolism causing spinal cord infarctions. The efficacy of thrombolytic therapy in spinal cord infarction is not well established.</p><p><strong>Case report: </strong>A 56-year-old male with hypertension presented with acute onset left arm and leg weakness after a Valsalva maneuver. The exam was remarkable for dense flaccid paralysis of the left arm and leg. Patient received thrombolytic therapy for suspicion of stroke. MRI C-spine revealed a nonenhancing lesion from C2 to C5 with diffusion restriction on DWI, suggesting a spinal infarct. He received 5 days of high-dose steroids with mild improvement of left lower extremity weakness. Labs were unremarkable for underlying inflammatory or demyelinating causes of myelopathy. We ruled out aortic dissection and cardioembolic causes. Upon further evaluation, the patient endorsed lifting heavy weights and had cervical spondylosis on imaging, which led to the diagnosis of fibrocartilaginous embolism. On 1-year follow-up, he is walking without support with some motor improvement in the distal left upper extremity.</p><p><strong>Conclusions: </strong>It is important to have a wide differential diagnosis in acute cases of myelopathy. In our patient's case, his diagnosis was one of exclusion. This case highlights a rare cause of spinal cord infarction in a middle-aged man. The efficacy of thrombolytic therapy in such cases needs further investigation.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"219-222"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333981","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":"ZJUSXH Model: A Multilayer Model for Predicting 90-Day Neurological Outcome After Endovascular Thrombectomy in Acute Large Vessel Occlusion Stroke.","authors":"Jianli Wang, Feng Yang, Chengdong Sun, Chenglong Ye, Pan Li, Huan Tang, Guoliang Qian, Huaming Li, Zigang Yuan","doi":"10.1097/NRL.0000000000000684","DOIUrl":"10.1097/NRL.0000000000000684","url":null,"abstract":"<p><strong>Objectives: </strong>Stroke is a leading cause of mortality and disability worldwide, particularly acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Although endovascular intervention has proven effective, individual outcomes vary considerably. This study aimed to identify key prognostic factors and develop a predictive model for neurological recovery in patients with LVO-AIS following endovascular thrombectomy (EVT).</p><p><strong>Methods: </strong>A total of 191 LVO-AIS patients who underwent EVT at the Neurosurgery Department of Zhejiang University Shaoxing Hospital from January 2022 to June 2023 were included in the analysis. Prognostic factors collected included demographic information, premorbid characteristics, initial laboratory data, neurological evaluation, and others. The 90‑day modified Rankin Scale (mRS) score served as the primary clinical outcome. A multilevel prognostic (MLP) model and an associated nomogram were developed to identify significant predictors and visualize their individual contributions to the outcome.</p><p><strong>Results: </strong>The Zhejiang University Shaoxing Hospital (ZJUSXH) model was developed, incorporating 11 key predictors: the National Institutes of Health Stroke Scale (NIHSS) score, symptom onset‑to‑recanalization (OTR) time, fasting blood glucose (FBS), hemoglobin (HGB), serum albumin (ALB), symptomatic intracerebral hemorrhage (sICH), the Controlling Nutritional Status (CONUT) score, the prognostic nutritional index (PNI), swallowing function, and the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. The overall predictive accuracy of the model was 86.2%.</p><p><strong>Conclusion: </strong>The NIHSS score and OTR time emerged as the most critical prognostic factors. FBS, HGB, ALB, sICH, swallowing function, and TOAST classification were also significant predictors. In addition, the CONUT score and PNI showed a significant association with neurological outcomes. Both the developed ZJUSXH model and its corresponding nomogram demonstrated high predictive accuracy.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"201-210"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585759","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":"Value of Cardiac Structural Metrics in Identifying Cardioembolic Stroke: A Cross-Sectional Study.","authors":"Guojuan Chen, Ling Ling, Peng Ding, Chao Zhang, Yuling Yang, Jingjing Li, Tong Zhang, Ruihua Guan, Jing Liu, Yibin Cao, Wei Yue","doi":"10.1097/NRL.0000000000000685","DOIUrl":"10.1097/NRL.0000000000000685","url":null,"abstract":"<p><strong>Objectives: </strong>Paroxysmal atrial fibrillation (AF) is often challenging to detect in the acute phase of ischemic stroke. This study aimed to assess the diagnostic value of readily available cardiac structural metrics in identifying cardioembolic stroke etiology.</p><p><strong>Methods: </strong>In a single-center cohort study, we enrolled patients who underwent transthoracic echocardiography within 7 days of stroke onset. We measured the left atrium diameter (LAD), right atrium diameter (RAD), left ventricular internal diameter, right ventricular internal diameter, interventricular septal thickness at end-diastole (IVSd), left ventricular posterior wall thickness, and assessed for mitral and aortic regurgitation. The predictive performance of these metrics for cardioembolic stroke was evaluated by calculating the area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>Among the 1357 enrolled patients, 101 (7.4%) were diagnosed with cardioembolic stroke. After adjusting for potential confounders, LAD, RAD, and IVSd remained independently associated with cardioembolic stroke in both the full population and in patients without AF. LAD demonstrated the highest discriminative ability, with an AUC of 0.744 (95% CI: 0.682-0.806). The AUCs for RAD and IVSd were 0.583 (0.510-0.657) and 0.584 (0.516-0.652), respectively.</p><p><strong>Conclusions: </strong>LAD is a good predictor for identifying cardioembolic stroke, independent of AF status. Cardiac structural metrics, particularly LAD, may aid in etiologic subtyping during the acute phase of ischemic stroke.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"195-200"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148609443","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":"Commentary: Cervical Artery Dissection and Chiropractic Cervical Manipulation: Clarifying Association, Mechanism, and Interpretation.","authors":"Nancy Maalouf, Shadi Yaghi","doi":"10.1097/NRL.0000000000000681","DOIUrl":"10.1097/NRL.0000000000000681","url":null,"abstract":"","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"226-227"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148334017","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":"Brain Abscesses as a Complication of Brain Hematomas in Infective Endocarditis: A Rare Case Report.","authors":"Monique Boukobza, Augustin Gaudemer, Gueorgui Iakovlev, Claire Hobson, Jean-Pierre Laissy","doi":"10.1097/NRL.0000000000000687","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000687","url":null,"abstract":"<p><strong>Introduction: </strong>Brain abscesses developing within a nonoperated intracranial hematoma are even rarer. We report brain abscesses developing within 2 hematomas and complicating a methicillin-sensitive Staphylococcus aureus (MSSA) infectious endocarditis (IE).</p><p><strong>Case: </strong>A previously healthy 26-year-old man without risk factors was diagnosed at hospital day (HD) 2 with a parietal hematoma (24 mm). Angiography did not reveal any aneurysm. He underwent a biological aortic valve replacement at HD4. Valve culture was positive for MSSA. Subsequently, a frontal hematoma appeared, an enlargement of both hematomas, extensive and finger-like edema, and ring enhancement. The puncture of the largest abscess showed red jelly-like material, and the culture was positive for MSSA. Thereafter, the lesions progressively disappeared.</p><p><strong>Conclusion: </strong>We emphasize the difficulty of the diagnosis of brain abscess developing within a hematoma, due to the possible absence of clinical changes. However, clinicians should be aware of possible MRI changes. A contrast-enhanced sequence is of paramount importance in the follow-up of brain hematomas in IE patients.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867618","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":"Polyneuropathy, Organomegaly, Endocrinopathy, M-Protein, and Skin Changes (POEMS) Syndrome With Characteristic Muscle Biopsy Findings and Without M-Protein.","authors":"Josephine Yalovitser, Muhannad Seyam, John DeWitt, Rup Tandan, Waqar Waheed","doi":"10.1097/NRL.0000000000000688","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000688","url":null,"abstract":"<p><strong>Introduction: </strong>POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, and Skin changes) syndrome is a rare paraneoplastic disorder driven by proinflammatory cytokines, particularly vascular endothelial growth factor (VEGF), which promotes multisystemic angiogenesis and inflammation. It is frequently misdiagnosed as Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) due to overlapping features.</p><p><strong>Case report: </strong>A 63-year-old woman was referred for presumed CIDP unresponsive to IVIG and steroids. Her clinical course was notable for 100-pound weight loss, papilledema, skin changes, thrombocytosis, thromboembolisms, hemi-diaphragmatic paralysis, organomegaly/lymphadenopathy, and negative bone marrow and lymph node biopsies. POEMS was diagnosed based on repeat electrodiagnostic testing, elevated VEGF and prolactin, and nerve/muscle biopsies showing endomysial edema and angiogenesis. Notably, no monoclonal protein (M-protein) was identified. Treatment with lenalidomide and dexamethasone resulted in significant clinical improvement.</p><p><strong>Conclusion: </strong>Paraprotein-negative POEMS syndrome should be considered in refractory CIDP, especially in the presence of skin changes, endocrinopathy, papilledema, and thrombocytosis. VEGF levels and nerve/muscle biopsy findings are critical diagnostic tools in patients with high clinical suspicion who lack monoclonal gammopathy. Muscle biopsy may increase the diagnostic yield by revealing characteristic vascular proliferation, a feature previously described in nerve biopsies of patients with POEMS syndrome.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800559","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":"Anti-Contactin-1 Nodopathy Presenting With Dysphagia and Nephrotic Syndrome: Remarkable Neurological and Renal Recovery Following Early B-Cell-Targeted Therapy.","authors":"Shao-Ting Tai, Chien-Jung Lu","doi":"10.1097/NRL.0000000000000689","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000689","url":null,"abstract":"<p><strong>Introduction: </strong>Although the typical phenotype of anticontactin-1 (CNTN1) nodopathy has been well characterized, dysphagia has received limited attention in the literature. We report a patient with anti-CNTN1 nodopathy presenting with dysphagia and nephrotic syndrome who achieved marked neurological and renal recovery following early B-cell-depleting therapy.</p><p><strong>Case report: </strong>A 77-year-old man with hypertension, dyslipidemia, diabetes mellitus, and pre-existing heavy proteinuria developed rapidly progressive distal numbness, limb weakness, sensory ataxia, mild dysphagia, and functional decline. Neurological examination demonstrated symmetric limb weakness, generalized areflexia, sensory impairment, pseudoathetosis, and ataxia. Nerve conduction studies revealed a demyelinating polyneuropathy, and cerebrospinal fluid analysis showed albuminocytologic dissociation (protein 271 mg/dL). Gadolinium-enhanced brain magnetic resonance imaging was unremarkable despite bulbar symptoms. Anti-CNTN1 antibody testing confirmed autoimmune nodopathy. Treatment with high-dose corticosteroids followed by rituximab (two 1 g infusions) resulted in neurological improvement within 1 month, with complete resolution of dysphagia, restoration of independent ambulation, and progressive functional recovery. The Inflammatory Neuropathy Cause and Treatment (INCAT) disability score improved from 4 to 0 over 7 months. Concurrently, nephrotic-range proteinuria markedly improved, demonstrating parallel neurological and renal recovery.</p><p><strong>Conclusion: </strong>This case highlights several important features of anti-CNTN1 nodopathy, including neuro-renal coupling, dysphagia as a potentially under-recognized manifestation of bulbar involvement, and an unusually favorable outcome following early B-cell-depleting therapy. Diabetes may complicate recognition of the disorder by mimicking both neuropathic and renal manifestations. Together with the reported association between anti-CNTN1 nodopathy and malignancy, the clinical heterogeneity of this condition underscores the importance of early antibody testing and prompt targeted immunotherapy.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764097","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 Eight-and-a-Half to Nine: A Case Report Highlighting an Uncommon Brainstem Syndrome.","authors":"Jamir Pitton Rissardo, Vishnu Vardhan Byroju, Arthur Gribachov, Ana Letícia Fornari Caprara, Olga R Thon, Ahmad Ballout","doi":"10.1097/NRL.0000000000000670","DOIUrl":"10.1097/NRL.0000000000000670","url":null,"abstract":"<p><strong>Introduction: </strong>Nine syndrome is a rare clinical brainstem syndrome combining one-and-a-half syndrome with ipsilateral facial weakness and long-tract signs such as contralateral hemiparesis or hemiataxia. It typically results from pontine tegmentum lesions, most often due to acute ischemic stroke. We conducted a systematic review of published cases using PubMed, Scopus, and Web of Science (search until October 2025). Data on demographics, clinical features, imaging, etiology, and outcomes were summarized descriptively.</p><p><strong>Case report: </strong>A 73-year-old woman with vascular risk factors presented with diplopia, ipsilateral facial weakness, and contralateral arm weakness, consistent with nine syndrome. MRI revealed infarction in the left dorsal pons and ventral medulla. Stroke etiology was attributed to small-vessel ischemic disease. She was started on dual antiplatelet as well as aggressive risk factor management. At 4-month follow-up, her motor symptoms had largely improved, albeit with residual diplopia. Literature review identified 25 cases with similar presentation (mean age 57.7 years; 66.7% male). Contralateral hemiparesis occurred in 52%, hemiataxia in 24%, and sensory deficits in 32%. Ischemic stroke was the leading cause (68%), followed by hemorrhagic stroke (20%) and demyelinating conditions (12%). Complete recovery was rare (4%), with most cases showing partial improvement.</p><p><strong>Conclusion: </strong>Nine syndrome reflects a strategically located pontine lesion disrupting multiple adjacent structures. Ischemic stroke predominates, highlighting the need for early MRI and vascular imaging. Recognition of this rare syndrome aids accurate diagnosis and targeted management.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"184-189"},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943569","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":"Hitting A Nerve: T1 Nerve Root Injury Secondary to Open Heart Surgery.","authors":"Nicole Varda, Jacob A Saunders, Thomas C Varkey, Faraz Behzadi, Savdeep Singh","doi":"10.1097/NRL.0000000000000678","DOIUrl":"10.1097/NRL.0000000000000678","url":null,"abstract":"<p><strong>Introduction: </strong>Patients who undergo cardiothoracic surgery and sternotomy can experience cardiovascular complications from manipulation of the great vessels or artificial pump bypass of the heart, raising the fear of stroke in the setting of focal neurological deficit. However, this study reveals a less common but often as focal and debilitating complication of these surgeries from direct injury of the peripheral nerves under prolonged physical tension.</p><p><strong>Case study: </strong>This case details the presentation of a 72-year-old woman who developed acute left upper extremity weakness following elective open-heart surgery. Imaging ruled out ischemic or hemorrhagic stroke, and instead revealed a brachial plexus injury, with the most severe injury being on the T1 nerve root. This injury, leading to left upper extremity weakness, was diagnosed after advanced imaging and physical examination. The patient's symptoms gradually improved with supportive management and physical therapy.</p><p><strong>Conclusion: </strong>This case underscores the importance of considering nerve injuries in the differential diagnosis of postoperative weakness and highlights the role of advanced imaging and electromyography in confirming brachial plexus injuries. Early recognition and appropriate management are essential for optimizing recovery in patients with iatrogenic brachial plexopathy.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"179-183"},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145210","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":"Frequency of Abnormal Neurological Examinations in a Subspecialty Headache Clinic: A Retrospective Chart Review.","authors":"Sabrina W Leung, Olivia C Iverson, A Laine Green","doi":"10.1097/NRL.0000000000000671","DOIUrl":"10.1097/NRL.0000000000000671","url":null,"abstract":"<p><strong>Objectives: </strong>Identify the frequency of abnormal neurological examinations among patients presenting in person for headache consultation. Determine what proportion of patients with abnormal examinations have accompanying red flags in their histories and/or undergo diagnostic workup.</p><p><strong>Methods: </strong>We conducted a retrospective review of patients presenting in person for headache consultation at a tertiary/quaternary headache clinic between June 2022 and May 2023. We excluded examination abnormalities consistent with known comorbidity, functional neurological disorder, and/or non-headache disease. We then calculated the proportion of patients with an abnormal neurological examination. For patients with abnormal examinations, the electronic medical record was further reviewed for red-flag components in the history, diagnostic workup ordered, and the resulting diagnosis.</p><p><strong>Results: </strong>Of 1281 patients presenting for in-person headache consultation, 218 (17%) had abnormal neurological examinations that were not consistent with known comorbidity, functional neurological disorder, or non-headache disease. Of these, 203 (93%) had a red flag in their history. The remaining 15 patients with abnormal examinations and no historical red flags comprised 1.2% of all 1281 patients. Regarding workup, 160 (73%) had neuro-imaging and 61 (28%) had laboratory studies ordered and/or requested for review, of which 13% and 8% were concerning for pathology, respectively.</p><p><strong>Conclusions: </strong>A small but notable proportion of patients presenting for in-person headache consultation had abnormalities on neurological examination. The majority of these patients received imaging, with a diagnostic yield higher than previously reported. However, the vast majority of patients with abnormal examinations also had red flags in their history to prompt diagnostic workup.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"141-150"},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145225","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}