Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery最新文献

{"title":"Long-term quality of life after ETV or ETV with consecutive VP shunt placement in hydrocephalic pediatric patients.","authors":"Victoria Bogaczyk,&nbsp;Steffen Fleck,&nbsp;Julia Berneiser,&nbsp;Michael Opolka,&nbsp;Marcus Vollmer,&nbsp;Jörg Baldauf,&nbsp;Christin Maria Gasch,&nbsp;Eva Maria Lemke,&nbsp;Ehab El Refaee,&nbsp;Marc Matthes,&nbsp;Holger Hirschfeld,&nbsp;Heinz Lauffer,&nbsp;Michael Gaab,&nbsp;Henry Schroeder,&nbsp;Sascha Marx","doi":"10.1007/s00381-022-05590-9","DOIUrl":"https://doi.org/10.1007/s00381-022-05590-9","url":null,"abstract":"<p><strong>Purpose: </strong>Endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunting are well-established treatments of obstructive hydrocephalus (HCP) in adult and pediatric patients. However, there is a lack of data with regard to the quality of life (QoL) of these patients during long-term follow-up METHODS: Inclusion criteria were pediatric patients with endoscopic treatment of hydrocephalus at the University Medicine Greifswald between 1993 and 2016. Patients older than 14 years at present were assessed with the Short Form-12 (SF-12) questionnaire. Patients younger than 14 years of age were assessed with the KINDL-R questionnaire that was completed by their parents. Patients' values were compared with the scores of a corresponding age-matched group of the healthy population and with patients who received later shunt treatment. Information about comorbidities, current symptoms, and educational level were gained by an additional part. Comparative analysis between patients with ETV success and failure (defined as shunt implantation after ETV) was performed.</p><p><strong>Results: </strong>A total of 107 patients (53 m, 54f) were included. Fifty-seven/107 patients (53.3%) were considered as ETV success. Mean age at ETV was 6.9 ± 5.9 years. Fifty-four statements of 89 patients that are still alive were gained (response rate 63%). Of these, 49 questionnaires were complete and evaluable (23 m, 26f; mean age 19.8 ± 10.0 years with an average follow-up period of 13.7 ± 7.2 years). Twenty-six/49 patients (53.1%) are considered ETV success. No statistically significant differences could be obtained between patients with ETV success and ETV failure. Patients older 14 years show QoL within normal range, patients younger than 14 years show significantly lower result regarding their environment of peers and social contacts. Patients younger than 6 months at the time of ETV and patients with posthemorrhagic HCP show significantly lower physical QoL. Gait disturbance, fatigue, and seizures are associated with a lower QoL, and educational level is lower than in the normal population.</p><p><strong>Conclusions: </strong>Patients who underwent ETV in childhood do not have a lower health-related QoL in general. Subsequent insertions of ventriculoperitoneal (vp) shunts do not lower QoL. Certain subgroups of the patients show lower results compared to the healthy population.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":" ","pages":"1885-1894"},"PeriodicalIF":1.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9522746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40473889","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":"Correction to: Long‑term quality of life after ETV or ETV with consecutive VP shunt placement in hydrocephalic pediatric patients.","authors":"Victoria Bogaczyk,&nbsp;Steffen Fleck,&nbsp;Julia Berneiser,&nbsp;Michael Opolka,&nbsp;Marcus Vollmer,&nbsp;Jörg Baldauf,&nbsp;Christin Maria Gasch,&nbsp;Eva Maria Lemke,&nbsp;Ehab El Refaee,&nbsp;Marc Matthes,&nbsp;Holger Hirschfeld,&nbsp;Heinz Lauffer,&nbsp;Michael Gaab,&nbsp;Henry W S Schroeder,&nbsp;Sascha Marx","doi":"10.1007/s00381-022-05657-7","DOIUrl":"https://doi.org/10.1007/s00381-022-05657-7","url":null,"abstract":"","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":" ","pages":"1895"},"PeriodicalIF":1.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9522692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40354651","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":"Risk factors for proximal junctional kyphosis after pediatric spinal deformity surgery with halo gravity traction.","authors":"Amir Amanullah,&nbsp;Martin Piazza,&nbsp;Bilal Qutteineh,&nbsp;Amer F Samdani,&nbsp;Joshua M Pahys,&nbsp;Brandon J Toll,&nbsp;Andrew Jeongyoon Kim,&nbsp;Steven W Hwang","doi":"10.1007/s00381-022-05596-3","DOIUrl":"https://doi.org/10.1007/s00381-022-05596-3","url":null,"abstract":"<p><strong>Purpose: </strong>To determine risk factors for proximal junctional kyphosis (PJK) in pediatric patients with scoliosis undergoing halo gravity traction (HGT) prior to posterior spinal fusion (PSF).</p><p><strong>Methods: </strong>Data from consecutive patients who underwent PSF after HGT with 2-year follow-up were retrospectively collected from a single center. Patients were divided into two groups: PJK vs. no PJK.</p><p><strong>Results: </strong>Twenty-five patients (age 13.6 ± 3.1 years) underwent HGT for a mean of 42 ± 37 days. Eight patients (32%) developed radiographic PJK and 1 (4%) developed proximal junctional failure. PJK patients had greater loss of cervical lordosis (-17.4 ± 23.2 vs. 2.7 ± 16.2°, p < 0.05), greater increase in lumbar lordosis (9.3 ± 19.5 vs. -2.8 ± 12.8°; p = 0.034) during traction, and smaller overall major coronal curve angle correction (-16.8 ± 30.6 vs. -36.6 ± 16.4°; p = 0.026). From postoperative to last follow-up, PJK patients had a greater increase in upper end vertebrae (UEV) slope (3.3 ± 7.8 vs. -4.0 ± 7.7°; p = 0.004). Selection of UIV based on which vertebra was most level either pre-traction or in-traction was not associated with PJK development (p > 0.05).</p><p><strong>Conclusion: </strong>In-traction radiographic changes of decreased cervical lordosis, decreased major coronal curve, increased lumbar lordosis, and disruption of cervical sagittal balance at last follow-up may have implications for level selection and risk of PJK.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":" ","pages":"1913-1922"},"PeriodicalIF":1.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40534980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presentation, management and outcome of surgically managed pediatric thoracic outlet syndrome.","authors":"Nikhil K Murthy,&nbsp;Rashmi Kabre,&nbsp;Kristine S Corkum,&nbsp;Mandana Behbahani,&nbsp;Vineeth Thirunavu,&nbsp;Constantine L Karras,&nbsp;Tord D Alden","doi":"10.1007/s00381-022-05592-7","DOIUrl":"https://doi.org/10.1007/s00381-022-05592-7","url":null,"abstract":"<p><strong>Purpose: </strong>Thoracic outlet syndrome (TOS) is a rare disorder involving compression of the brachial plexus, subclavian artery, and subclavian vein. There is a paucity of data for this pathology's surgical treatment within pediatrics. The objective of this study is to explore the presentation, management, and outcome of pediatric TOS.</p><p><strong>Methods: </strong>A retrospective chart review was conducted for 44 patients at a single institution undergoing surgery for TOS. Data was collected on demographics, pre- and postoperative factors, and outcomes.</p><p><strong>Results: </strong>Forty-four patients underwent 50 surgeries (8 bilaterally). The average age was 15.5 years with 72% female. The most common symptoms were numbness (72%) and pain (66%), with a normal exam in 58%. The average symptom duration prior to surgery was 35.2 months. A supraclavicular approach was performed in all patients, with anterior scalene section (90%), rib resection (72%), neurolysis (92%), and intraoperative EMG (84%) commonly used. Two patients had a lymphatic leak. All patients reported subjective improvement of preoperative symptoms of numbness (26%), pain (22%), and weakness (6%). Differences between vTOS (n = 9) and nTOS (n = 35) included higher preop swelling (p < 0.012), decreased symptom duration (p < 0.022), higher venogram usage (p < 0.0030), and higher preoperative thrombolytics/angioplasty (p < 0.001) in vTOS compared to nTOS. A comparison of soft tissue and soft tissue with bone decompression did not reveal any outcome differences.</p><p><strong>Conclusion: </strong>Pediatric TOS benefits from a multidisciplinary approach, showing good outcomes in postoperative symptom resolution. In our cohort, a supraclavicular approach provided an effective window for decompression with a low complication rate.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":" ","pages":"1949-1954"},"PeriodicalIF":1.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40712251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cranial irradiation induces cognitive decline associated with altered dendritic spine morphology in the young rat hippocampus.","authors":"Xin Ding,&nbsp;Hai-Bo Zhang,&nbsp;Hui Qiu,&nbsp;Xin Wen,&nbsp;Long-Zhen Zhang","doi":"10.1007/s00381-022-05646-w","DOIUrl":"https://doi.org/10.1007/s00381-022-05646-w","url":null,"abstract":"<p><strong>Objective: </strong>Therapeutic irradiation is commonly used to treat brain cancers but can induce cognitive dysfunction, especially in children. The mechanism is unknown but likely involves alterations in dendritic spine number and structure.</p><p><strong>Methods: </strong>To explore the impact of radiation exposure on the alteration of dendritic spine morphology in the hippocampus of young brains, 21-day-old Sprague-Dawley rats received cranial irradiation (10 Gy), and changes in spine density and morphology in dentate gyrus (DG) granules and CA1 pyramidal neurons were detected 1 and 3 months later by using Golgi staining. Moreover, we analyzed synapse-associated proteins within dendritic spines after irradiation.</p><p><strong>Result: </strong>Our data showed that cognitive deficits were detected in young rats at both time points postirradiation, accompanied by morphological changes in dendritic spines. Our results revealed significant reductions in spine density in the DG at both 1 month (40.58%) and 3 months (28.92%) postirradiation. However, there was a decrease in spine density only at 1 month (33.29%) postirradiation in the basal dendrites of CA1 neurons and no significant changes in the apical dendrites of CA1 neurons at either time point. Notably, among our findings were the significant dynamic changes in spine morphology that persisted 3 months following cranial irradiation. Meanwhile, we found that depletion of the synapse-associated proteins PSD95 and Drebrin coincided with alterations in dendritic spines.</p><p><strong>Conclusion: </strong>These data suggest that the decreased levels of PSD95 and Drebrin after ionizing radiation may cause changes in synaptic plasticity by affecting the morphological structure of dendritic spines, blocking the functional connectivity pathways of the brain and leading to cognitive impairment. Although the mechanism involved is unclear, understanding how ionizing radiation affects young brain hippocampal tissue may be useful to gain new mechanistic insights into radiation-induced cognitive dysfunction.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":" ","pages":"1867-1875"},"PeriodicalIF":1.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40720026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there a role in the central nervous system development for using corticosteroids to treat meningomyelocele and hydrocephalus?","authors":"I José Nogueira Gualberto,&nbsp;G Araújo Medeiros,&nbsp;M Volpon Santos,&nbsp;L da Silva Lopes,&nbsp;H Rubens Machado,&nbsp;L Sbragia","doi":"10.1007/s00381-022-05615-3","DOIUrl":"https://doi.org/10.1007/s00381-022-05615-3","url":null,"abstract":"<p><strong>Introduction: </strong>Myelomeningocele (MMC) is the most frequent neural tube defect and is frequently associated (around 80% of cases) with hydrocephalus (HC). Both diseases can have severe clinical consequences, insomuch as they require surgical treatment whose complications are not negligible, either when performed in utero or after birth. Therefore, clinical therapies that could have an impact on the incidence and progression of MMC and HC would be certainly valuable; however, this is not the current picture, and there are no effective pharmacological treatments for such patients to this day.</p><p><strong>Aim and methods: </strong>Therefore, knowing that an inflammatory process comes associated with these disorders, mostly due to nervous tissue distension, the present article aimed at reviewing the role of corticosteroids in reducing inflammation and thus improving the outcome of patients with HC and MMC, considering the well-established anti-inflammatory effects of CS.</p><p><strong>Results: </strong>The systematic review performed herein has found varying results regarding the role of steroids (even though a positive trend was observed) on the treatment and prevention of hydrocephalus, whereas for MMC.</p><p><strong>Conclusion: </strong>There are many reports demonstrating beneficial effects of CS therapy, from a clinical and histopathological point of view.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":" ","pages":"1849-1854"},"PeriodicalIF":1.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40651984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-biting behavior in patients with neonatal brachial plexus palsy.","authors":"Carlos Otto Heise,&nbsp;Monise Zaccariotto,&nbsp;Roberto S Martins,&nbsp;Hugo Sterman-Neto,&nbsp;Mário G Siqueira","doi":"10.1007/s00381-022-05574-9","DOIUrl":"https://doi.org/10.1007/s00381-022-05574-9","url":null,"abstract":"<p><strong>Purpose: </strong>Self-biting behavior in patients with neonatal brachial plexus palsy (NBPP) has been associated with finger amputation. Our objective is to describe the incidence of this complication, risk factors, and clinical management.</p><p><strong>Methods: </strong>We retrospectively analyzed 612 patients with NBPP. There were 303 males and 309 females. 51.8% of patients had C5-C6 lesions, 28.9% had C5-C7, 18.9% had C5-T1, and 0.3 had C7-T1 involvement.</p><p><strong>Results: </strong>We identified 15 patients with self-biting behavior (2.5%). Ten patients had C5-T1 lesions, and five had C5-C7 lesions. Eight patents were submitted to brachial plexus surgery and seven were not. This behavior appeared between 8 and 46 months of life (mean 23.5), and it was always temporary. There was no difference between operated and non-operated patients (p > 0.05), and no correlation between age at surgery and age of appearance of self-biting behavior (p > 0.05). Physical restriction was effective in treating this complication and we had no case of finger amputation.</p><p><strong>Conclusion: </strong>Self-biting behavior is a rare complication of NBPP, and it is usually associated with severe motor involvement. The behavior duration is limited to a few months. This condition can be effectively treated with physical restriction to prevent hand biting.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":" ","pages":"1773-1776"},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40073024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumocephalus as a complication of spinal anesthesia in a child.","authors":"Marco Maglione,&nbsp;Stefania Graziano,&nbsp;Carmela Russo,&nbsp;Antonietta Giannattasio,&nbsp;Vincenzo Tipo","doi":"10.1007/s00381-022-05618-0","DOIUrl":"https://doi.org/10.1007/s00381-022-05618-0","url":null,"abstract":"","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":" ","pages":"1659-1661"},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40557103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal astroblastoma: a rare tumour in an unusual location.","authors":"Shilpa Rao,&nbsp;T A Nufina,&nbsp;Harsha Sugur,&nbsp;Kirit Arumalla,&nbsp;B Indira Devi,&nbsp;Vani Santosh","doi":"10.1007/s00381-022-05468-w","DOIUrl":"https://doi.org/10.1007/s00381-022-05468-w","url":null,"abstract":"<p><p>Astroblastomas are central nervous system tumours with unknown cell of origin and clinical behaviour. These tumours occur most commonly in cerebral hemispheres with spinal astroblastomas being very rare. We report a case of spinal astroblastoma which harboured MN1 alteration.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":" ","pages":"1797-1801"},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39913548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Favourable long-term recovery after decompressive craniectomy: the Northern Finland experience with a predominantly adolescent patient cohort.","authors":"Tommi K Korhonen,&nbsp;Maria Suo-Palosaari,&nbsp;Willy Serlo,&nbsp;Maija J Lahtinen,&nbsp;Sami Tetri,&nbsp;Niina Salokorpi","doi":"10.1007/s00381-022-05568-7","DOIUrl":"https://doi.org/10.1007/s00381-022-05568-7","url":null,"abstract":"<p><strong>Purpose: </strong>Decompressive craniectomy (DC) is an effective treatment of intracranial hypertension. Correspondingly, the procedure is increasingly utilised worldwide. The number of patients rendered vegetative following surgery has been a concern-a matter especially important in children, due to long anticipated lifetime. Here, we report the long-term outcomes of all paediatric DC patients from an 11-year period in a tertiary-level centre that geographically serves half of Finland.</p><p><strong>Methods: </strong>We identified all patients younger than 18 years who underwent DC in the Oulu University Hospital between the years 2009 and 2019. Outcomes and clinicoradiological variables were extracted from the patient records.</p><p><strong>Results: </strong>Mean yearly prevalence of brain injury requiring DC was 1.34/100 000 children-twenty-four patients underwent DC during the study period and 21 (88%) survived. The median age of the patients was 16.0 years, and the median preoperative GCS was 5.0 (IQR 5.0). Fifteen patients (63%) had made a good recovery (Extended Glasgow Outcome Scale ≥ 7). Of the surviving patients, two (9.5%) had not returned to school. After traumatic brain injury (n = 20), the Rotterdam CT score (mean 3.0, range 1 to 5) was not associated with mortality, poor recovery or inability to continue school (p = 0.13, p = 0.41, p = 0.43, respectively). Absent basal cisterns were associated with mortality (p = 0.005), but not with poor recovery if the patient survived DC (p = 0.81). Hydrocephalus was associated with poor recovery and inability to continue school (p = 0.01 and p = 0.03, respectively).</p><p><strong>Conclusion: </strong>Most of our patients made a favourable recovery and were able to continue school. No late mortality was observed. Thus, even in clinically and radiologically severely brain-injured children, decompressive craniectomy appears to yield favourable outcomes.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":" ","pages":"1763-1772"},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9463249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40333050","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}