Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale最新文献

{"title":"Surgical options for advanced otosclerosis.","authors":"Stefano Berrettini, Francesco Lazzerini, Luca Bruschini, Lorena Di Girolami, Silvia Capobianco, Davide Bernacca, Francesca Forli","doi":"10.14639/0392-100X-suppl.1_3-45-2025-A1338","DOIUrl":"10.14639/0392-100X-suppl.1_3-45-2025-A1338","url":null,"abstract":"<p><strong>Objective: </strong>Management of advanced otosclerosis (AO) has evolved over the past 20 years with the availability of cochlear implant (CI) in addition to stapes surgery. Both procedures are reliable treatment options for AO with similar success rates and currently there are no standard guidelines regarding the surgical treatment of AO. The aim of this paper is to report the outcomes and complications of a series of patients with AO submitted to CI at our Institution. An extensive review of the literature is also provided.</p><p><strong>Methods: </strong>The study group was composed of 31 adult patients affected by AO, consecutively submitted to CI at our Institution. Postoperative results and complications were compared to those of a homogeneous control group of adult implanted patients, affected by post-verbal sensorineural hearing loss due to other aetiologies.</p><p><strong>Results: </strong>Patients in both groups achieved satisfactory results in terms of speech perception in quiet and with background noise after CI, without no significant differences. The rate of complications in the study group was 15%, which is similar to literature reports.</p><p><strong>Conclusions: </strong>In patients with AO, the decision between stapes surgery and CI must be personalised and well-considered, taking into account the individual characteristics of the patient and the potential risks and benefits of each option.</p>","PeriodicalId":520544,"journal":{"name":"Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale","volume":"45 Suppl. 1","pages":"S53-S60"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328321","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":"Ostiomeatal complex preservation: submucosal inferior meatal antrostomy for maxillary sinus pathologies.","authors":"Roee Landsberg, Shay Schneider, Muhammad Masarwa","doi":"10.14639/0392-100X-N2972","DOIUrl":"10.14639/0392-100X-N2972","url":null,"abstract":"<p><strong>Objective: </strong>Endoscopic inferior meatal antrostomy (EIMA) is feasible for treating maxillary sinus pathologies. We describe submucosal inferior meatal antrostomy (SIMA), a new ostiomeatal complex (OMC) sparing technique based on EIMA.</p><p><strong>Materials and methods: </strong>Medical records of patients who underwent SIMA for maxillary sinus pathologies were retrospectively reviewed. Data collected included age, gender, presenting symptoms, preoperative and postoperative endoscopic and computed tomography findings, early follow-up duration, and complications.</p><p><strong>Results: </strong>Twenty-two operated maxillary sinuses, in 20 patients, were included. Pathologies included displaced dental implant (n = 4), odontogenic sinusitis (n = 6), retention cyst (n = 5), antrochoanal polyp (n = 5) and fungus ball (n = 2). SIMA provided excellent access and view, and the OMC and the inferior meatus mucosa remained intact. Nineteen patients were completely cured following a rapid recovery and needed no further intervention. No intra-operative or postoperative complications occurred, and recirculation was not observed. One case failed due to a persistent odontogenic infection.</p><p><strong>Conclusions: </strong>SIMA provides an improved access and view when treating non-OMC-dependent maxillary sinus pathologies, while maintaining the integrity of the middle and inferior meatuses mucosa.</p>","PeriodicalId":520544,"journal":{"name":"Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale","volume":"45 3","pages":"200-206"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12201917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500237","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":"Italian adaptation of Listening Effort Assessment Scale and Fatigue Assessment Scale questionnaires.","authors":"Sara Ghiselli, Daria Salsi, Vincenzo Vincenti, Enrico Fabrizi, Patrizia Frontera, Domenico Cuda","doi":"10.14639/0392-100X-N2826","DOIUrl":"10.14639/0392-100X-N2826","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study is to adapt linguistically and culturally the Listening Effort Assessment Scale (EAS) and Fatigue Assessment Scale (FAS) questionnaires into Italian (EAS-IT and FAS-IT) and to investigate the reliability and validity of these scales in normal hearing and hearing-impaired subjects.</p><p><strong>Methods: </strong>The Italian adaptation of the EAS and FAS questionnaires was conducted based on back and forward translation methodology. Both questionnaires were administered to 101 normal hearing (NH) subjects and 88 hearing-impaired subjects including 19 hearing aid users (HA), 50 cochlear implant users (CI) and 19 affected by single-sided deafness (SSD).</p><p><strong>Results: </strong>Both questionnaires showed a high reliability (Cronbach's α was 0.953 for EAS-IT and 0.837 for FAS-IT). EAS-IT showed high internal consistency with item-rest correlations. The inter-item correlation of the FAS-IT shows a difference in the internal consistency of item 4. A high significance between the NH group and the 3 hearing loss groups (HA, CI, SSD) was found for EAS-IT, but no significant difference was found between NH and the single hearing-impaired groups for FAS-IT.</p><p><strong>Conclusions: </strong>EAS-IT showed good internal reliability and validity and is sensitive to hearing loss.</p>","PeriodicalId":520544,"journal":{"name":"Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale","volume":"45 3","pages":"207-216"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12201919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500235","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":"Microsurgery in primary tumours of the parapharyngeal space: observational retrospective analysis of a series of consecutive cases.","authors":"Antonio Mazzoni, Leonardo Franz, Elisabetta Zanoletti","doi":"10.14639/0392-100X-N3079","DOIUrl":"10.14639/0392-100X-N3079","url":null,"abstract":"<p><strong>Objective: </strong>To investigate safety and efficacy of the microsurgical approach to parapharyngeal space (PPS) tumour. A secondary goal was to evaluate the correspondence between preoperative and final histopathologic diagnosis after surgery.</p><p><strong>Methods: </strong>A consecutive series of primary PPS tumours treated between 1985 and 2022 in 2 tertiary referral centres with a microsurgical cervico-parotid approach was considered. The sample included 97 tumours (88 benign and 9 malignant) in 94 patients, of which 11 affected by recurrent tumours when first diagnosed at our centres. The surgical approaches, planned on the presumptive preoperative diagnosis, were pericapsular and en bloc resections (including either conservative or radical resections of the PPS).</p><p><strong>Results: </strong>Pericapsular and en bloc resections of the PPS achieved complete removal in 88 out of 97 tumours. Relapses after PPS microsurgery occurred only in 8 cases (4 pleomorphic adenomas, 2 malignant schwannomas, one melanoma, and one haemangiopericytoma). Four of the 8 relapsed cases were recurrent cases when first seen at our centres. A complete correspondence between preoperative diagnosis and final histology occurred only in the group of benign lesions classified as paraganglioma, schwannoma, or lipoma, submitted to pericapsular resection.</p><p><strong>Conclusions: </strong>Microsurgery may support the transcervical-parotid approach, by enhancing the operative space through narrow surgical corridors, improving dissection on critical cleavage planes, vessels and nerves, and allowing the exposure of both caudal and cranial extent of the lesions. In our series, pericapsular and en bloc resections of the PPS were effective in most of the included patients. In high-grade malignancies, where the morbidity of a wider resection beyond the PPS walls may include vessels and nerves, the indication should be accurately balanced.</p>","PeriodicalId":520544,"journal":{"name":"Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale","volume":"45 3","pages":"161-172"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12201923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500236","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":"Stapes revision surgery: intraoperative findings and audiological results. A multicentric study.","authors":"Luca Bruschini, Francesco Lazzerini, Silvia Capobianco, Ottavia Marconi, Andrea Canale, Andrea Albera, Enrico Covelli, Pietro Canzi, Andrea Laborai, Domenico Cuda, Stefano Berrettini","doi":"10.14639/0392-100X-suppl.1_3-45-2025-A1339","DOIUrl":"10.14639/0392-100X-suppl.1_3-45-2025-A1339","url":null,"abstract":"<p><strong>Objective: </strong>To explore the results of revision stapes surgery within a multicentric cohort, focusing on hearing improvements and correlation with the type of postoperative hearing loss experienced and related findings during the revision procedure.</p><p><strong>Methods: </strong>A retrospective study of 308 consecutive revision stapes surgeries performed ay 5 Otorhinolaryngologic Units in Pisa, Turin, Pavia, Piacenza, and Rome between 2010 and 2023 was accomplished.</p><p><strong>Results: </strong>The most frequent causes leading to revision stapes surgery were prosthesis dislocation (56.1%), use of a short prosthesis during primary surgery (13.9%), and an eroded incus (17.2%). The median air conduction threshold significantly improved after revision surgery, while the bone conduction threshold remained stable.</p><p><strong>Conclusions: </strong>Revision stapes surgery effectively improves hearing in patients with unsuccessful initial operations, with a significant reduction in the air-bone gap (ABG). The audiological results in our patients are favourable. ABG closure within 10 dB was achieved in 57.2% of cases and within 20 dB in 76% of cases. Stapes revision surgery is feasible and provides an acceptable success rate.</p>","PeriodicalId":520544,"journal":{"name":"Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale","volume":"45 Suppl. 1","pages":"S61-S70"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328320","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":"Airway assessment and management in head and neck cancer surgery.","authors":"Chiara Mossinelli, Giacomo Pietrobon, Stefano Zorzi, Marta Tagliabue, Francesco Chu, Emilia Tomarchio, Daniele Sances, Marco Venturino, Mohssen Ansarin","doi":"10.14639/0392-100X-A711","DOIUrl":"10.14639/0392-100X-A711","url":null,"abstract":"<p><strong>Objectives: </strong>Head and neck cancer surgery (HNCS) is burdened by a great risk of difficult airway and adverse events during anaesthesia. This study describes our experience and provides a flowchart for airway management in HNCS.</p><p><strong>Methods: </strong>We retrospectively reviewed 910 surgically treated patients (January 2022- January 2023, European Institute of Oncology, Milan, Italy). We selected malignant tumours of the upper airway and surgery performed under general anaesthesia. We report a descriptive analysis of the sample. The data collected were representative of our daily clinical practice and have been used to draw up a proposal for airway management in HNCS.</p><p><strong>Results: </strong>200 consecutive patients (males 71.5%, females 28.5%), median age 67 years, were selected. The most represented sites were larynx (44.5%), oral cavity (30.5%), and oropharynx (20%). Airway management was obtained by orotracheal intubation (61%), nasotracheal intubation (15%), awake intubation under fibreoptic endoscopic control (15%), and tracheostomy under local anaesthesia (9%). In 3 cases we performed tracheostomy in an emergency setting (all patients affected by laryngeal cancer in a locally advanced stage).</p><p><strong>Conclusions: </strong>Airway management in HNCS represents a topic of compelling interest that requires careful planning, well-defined options of strategies, and close communication between anaesthesiologists and surgeons.</p>","PeriodicalId":520544,"journal":{"name":"Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale","volume":"45 3","pages":"173-181"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12201920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500231","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":"Update on stapes surgery.","authors":"Luca Bruschini, Francesco Lazzerini, Andrea De Vito, Francesca Forli, Stefano Berrettini","doi":"10.14639/0392-100X-suppl.1_3-45-2025-A1336","DOIUrl":"10.14639/0392-100X-suppl.1_3-45-2025-A1336","url":null,"abstract":"","PeriodicalId":520544,"journal":{"name":"Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale","volume":"45 Suppl. 1","pages":"S29-S39"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328322","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":"Voice outcomes in patients with advanced laryngeal and hypopharyngeal cancer treated with chemo-radiotherapy.","authors":"César Álvarez-Marcos,&nbsp;Andrea Vicente-Benito,&nbsp;Águeda Gayol-Fernández,&nbsp;Daniel Pedregal-Mallo,&nbsp;Paloma Sirgo-Rodríguez,&nbsp;Liliana Santamarina-Rabanal,&nbsp;José Luis Llorente,&nbsp;Fernando López,&nbsp;Juan Pablo Rodrigo","doi":"10.14639/0392-100X-N1992","DOIUrl":"https://doi.org/10.14639/0392-100X-N1992","url":null,"abstract":"<p><strong>Objective: </strong>Patients with locally advanced laryngeal and hypopharyngeal cancer (LHC) are often treated with chemo-radiotherapy to avoid total laryngectomy, although voice problems may occur even if not markedly manifest. We sought to evaluate the impact of chemoradiation on voice and quality of life.</p><p><strong>Methods: </strong>We studied 21 patients with locally advanced LHC with tumour control at least two years after chemo-radiotherapy. None manifested clinical symptoms related to the treatment and maintained an activity considered as within normal limits. All patients had a voice handicap index (VHI) of less than 15. Voice function was evaluated by perceptual vocal analysis (CAPE-V) and aerodynamic and acoustic study. Quality of life was assessed with the EORTC-H&N35 (voice items 46, 53 and 54).</p><p><strong>Results: </strong>Voice changes were frequent, with alterations in all CAPE-V attributes, and predominantly type II and III spectrograms in acoustic analysis (78%). The EORTC-H&N35 scale showed a reduction in scores in 10-40% of items related to voice.</p><p><strong>Conclusions: </strong>Subclinical voice disorders are common after chemo-radiotherapy. Although patients consider vocal impairment to be very minor and to not interfere with their daily life, it may contribute to a reduced quality of life.</p>","PeriodicalId":520544,"journal":{"name":"Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale","volume":" ","pages":"243-249"},"PeriodicalIF":2.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/53/98/aoi-2022-03-243.PMC9330749.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40539123","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":"Evaluation of video head impulse test during vertiginous attack in vestibular migraine.","authors":"Ahmet Koç,&nbsp;Elvan Cevizci Akkılıç","doi":"10.14639/0392-100X-N1951","DOIUrl":"https://doi.org/10.14639/0392-100X-N1951","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to evaluate vestibular functions with video head impulse test (VHIT) and to understand the value of VHIT in differential diagnosis in patients with vestibular migraine (VM) during dizziness attack.</p><p><strong>Materials and methods: </strong>Two groups were enrolled in this study. The first consisted of 84 vestibular migraine patients, and second group of 74 healthy subjects. VHIT was applied to patients with VM during vertigo attack and the results were compared with the VHIT values applied to subjects in the control group.</p><p><strong>Results: </strong>The mean vestibulo-ocular reflex (VOR) in all semicircular canals in the VM group was lower than healthy individuals, but the results were not statistically significant. Refixation saccades were found in 52.3% of VM patients and in 10.2% of healthy individuals.</p><p><strong>Conclusions: </strong>When patients with VM were evaluated with VHIT during vertiginous attack, VOR gain values were not different from healthy individuals, but the number of catch-up saccades were higher in VM patients, which indicates peripheral vestibular involvement. For differential diagnosis in patients with VM, vestibular tests should be performed during the vertigo attack. When evaluating VHIT results, the presence of refixation saccades should also be evaluated.</p>","PeriodicalId":520544,"journal":{"name":"Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale","volume":" ","pages":"281-286"},"PeriodicalIF":2.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c5/49/aoi-2022-03-281.PMC9330756.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40539125","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":"The clinical significance of direction-fixed mono-positional apogeotropic horizontal nystagmus.","authors":"Mauro Gufoni,&nbsp;Augusto Pietro Casani","doi":"10.14639/0392-100X-N1824","DOIUrl":"https://doi.org/10.14639/0392-100X-N1824","url":null,"abstract":"<p><strong>Objective: </strong>A mono-positional persistent, direction-fixed apogeotropic nystagmus (MPosApoNy) is very challenging for the neuro-otologist. MPosApoNy can be found in patients suffering from a partially compensated acute unilateral vestibulopathy; with a normal caloric test, one can speculate the presence of \"trapped\" otolithic debris located close to the ampulla of the horizontal semicircular canal.</p><p><strong>Methods: </strong>Among 957 patients suffering from vertigo and dizziness, we selected 53 cases of MPosApoNy.</p><p><strong>Results: </strong>In 28 patients, caloric test showed a canal paresis on the same side of the MPosApoNy. In the remaining 25 cases, MPosApoNy was the only clinical finding. We hypothesised the presence of horizonal canal lithiasis and patients were treated with a Gufoni manoeuvre, followed by a forced prolonged position.</p><p><strong>Conclusions: </strong>Performing bedside examination in a patient suffering from vertigo, the presence of MPosApoNy may be due to: a) facilitation of a subclinical nystagmus due to the mechanism of apogeotropic reinforcement; b) horizontal canal lithiasis with 'trapped' otoliths close to the ampulla. The disappearance of MPosApoNy following a repositioning manoeuvre or conversion in a typical form of canalolithiasis may represent the best method to confirm this hypothesis.</p>","PeriodicalId":520544,"journal":{"name":"Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale","volume":" ","pages":"287-292"},"PeriodicalIF":2.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9a/ac/aoi-2022-03-287.PMC9330750.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40539126","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}