Chirurgia (Bucharest, Romania : 1990)最新文献

{"title":"Augmented Reality in Surgical Oncology. A Literature Review.","authors":"Virgiliu-Mihail Prunoiu,&nbsp;Dan Popa,&nbsp;Manole-Stelian Şerbulea,&nbsp;Eugen Brătucu,&nbsp;Laurenţiu Simion,&nbsp;Mircea Nicolae Brătucu","doi":"10.21614/chirurgia.2785","DOIUrl":"https://doi.org/10.21614/chirurgia.2785","url":null,"abstract":"<p><p><b>Introduction:</b> Augmented reality (AR) devices enable doctors to associate visualizing diagnostic data, to establish therapeutic procedures in order to improve work efficiency and safety and to develop the surgical training of young doctors. This new approach may contribute to an increase in the quality of medical training and a decrease in the costs of surgeries. This paper assesses whether augmented reality can improve the results of surgical procedures as well as its possible progress in the future. Methods and results: The intra-operative use of augmented reality by using Google Glass glasses, on which we projected MRI/CT images of the anatomical areas invaded by tumors and/or images of normal anatomy, helps us to perform surgeries, as well as to present them as teaching material. We have also performed a review of the available literature, beginning with 2011 and ending with November 2021, by looking up the terms \"augmented reality\" and \"surgical oncology\" in PubMed. The results of the search were 308 studies in this field which prove the utility of the method. Many papers show that the performance of the augmented reality systems is superior and compatible with traditional imaging techniques. <b>Conclusions:</b> The specialty literature reveals a growing interest on the part of surgeons regarding the use of augmented reality during surgery. This procedure enables the improvement of the safety and efficiency of surgical techniques, as well as their presentation to students and residents alike. The method is innovative and has to be carefully approached before being introduced into routine practice.</p>","PeriodicalId":520588,"journal":{"name":"Chirurgia (Bucharest, Romania : 1990)","volume":" ","pages":"517-525"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40660049","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":"Abberant Immunohistochemical Expression of OCT3/4 and EMT Related Markers, Vimentin and E-cadherin, is Correlated with Adverse Histopathological Features in Colorectal Adenocarcinoma.","authors":"Constantin Busuioc,&nbsp;Rodica Daniela Birla,&nbsp;Flavia Ultimescu,&nbsp;Sorin Duţulescu,&nbsp;Eugenia Panaitescu,&nbsp;Ioana Berindan-Neagoe","doi":"10.21614/chirurgia.2782","DOIUrl":"https://doi.org/10.21614/chirurgia.2782","url":null,"abstract":"<p><p><b>Background:</b> Although clinical management for colorectal cancer has been markedly improved, it is faced with a growing incidence among the young and among those in developing nations. Furthermore, diagnosis occurs mostly in advanced stages, when the therapeutic resources are limited. Therefore we need new biomarkers for diagnostics and therapeutic targets. The key event that leads to invasion and metastasis is the epithelial to mesenchymal transition (EMT), which can be studied with IHC markers. We aimed to corelate the expression of EMT related markers (Vimentin and E-cadherin) and a stem cell marker (OCT 3/4) with the clinicopathological parameters of the tumors. Material and <b>Methods:</b> Surgical resection specimens from 30 treatment-naive colon cancer patients, hospitalized from 2018 to 2021 were assessed. Immunohistochemical tests were performed to investigate the expression of EMT related markers and OCT 3/4 in tumor cells. <b>Results:</b> Vimentin, OCT3/4 positivity and loss of E-cadherin were significantly associated with tumor grade, tumor budding, invasive tumor front, and lymph node metastasis. <b>Conclusions:</b> Vimentin, E-cadherin and OCT 3/4 might serve as a panel of biomarkers that can aid in the prognostication of patients, with the added potential of being oncotargets.</p>","PeriodicalId":520588,"journal":{"name":"Chirurgia (Bucharest, Romania : 1990)","volume":" ","pages":"544-555"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40660505","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":"Tube Duodenostomy to Treat Large Duodenal Perforation: Our Experience and Literature Review.","authors":"Mario Pacilli,&nbsp;Giovanna Pavone,&nbsp;Alberto Fersini,&nbsp;Piercarmine Panzera,&nbsp;Antonio Ambrosi,&nbsp;Nicola Tartaglia","doi":"10.21614/chirurgia.2787","DOIUrl":"https://doi.org/10.21614/chirurgia.2787","url":null,"abstract":"<p><p><b>Background:</b> Duodenal perforation is a life-threatening condition and ideal approaches for the management of duodenal perforations are nowadays unclear, so numerous variables must be considered. Peptic ulcer disease is the most common disease determining a duodenal perforation, however, there may be other less common causes. <b>Methods:</b> We retrospectively analyzed all the patients who presented at our Division of General Surgery for a Duodenal Perforation, from September 2018 to December 2019. We focused on patients requiring a tube duodenostomy. Five patients were included in this study. <b>Results:</b> Five patients suffering from a duodenal perforation were analyzed and their data collected. All patients were treated with tube duodenostomy, pyloric exclusion and omega loop gastro-enteroanastomosis. The duodenostomy was removed four weeks after surgery. All patients suffered postsurgical complications ranging from wound infection to pneumonitis; the incidence of severe complications was greater in the older patients. We did not record any deaths four months after the operation. <b>Conclusions:</b> The tube duodenostomy is an old and dated procedure but simple to implement, which may require an increase in post-operative hospitalization, but which subsists as an effective and safe way to treat patients in critical conditions.</p>","PeriodicalId":520588,"journal":{"name":"Chirurgia (Bucharest, Romania : 1990)","volume":" ","pages":"594-600"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40660511","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":"Dermatofibrosarcoma Protuberans: One Centre Experience.","authors":"Theodor Mareş,&nbsp;Laura Răducu,&nbsp;Adelaida Avino,&nbsp;Daniela-Elena Gheoca-Mutu,&nbsp;Răzvan Nicolae Teodoreanu,&nbsp;Cristian-Radu Jecan","doi":"10.21614/chirurgia.2778","DOIUrl":"https://doi.org/10.21614/chirurgia.2778","url":null,"abstract":"<p><p><b>Background:</b> Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue tumor that is classified as a non-melanoma skin cancer. Surgical excision with wide safety margins is the cornerstone treatment and frequently requires advanced reconstruction methods for wound closure. This study aimed to report our experience with the management of seven consecutive patients with dermatofibrosarcoma protuberans. <b>Materials and Methods:</b> We performed a retrospective study of seven consecutive patients with dermatofibrosarcoma protuberans admitted to our Plastic and Reconstructive Surgery Department of Clinical Emergency Hospital \"Prof. Dr. Agrippa Ionescu\" Bucharest, Romania, between July 12, 2018, and July 4, 2022. <b>Results:</b> The mean age of the patients was 38.2 years. In 4 patients, the primary treatment consisted of wide local excision, while 3 presented to our clinic for re-resection. All cases required complex reconstruction methods 3 patients with a split-thickness skin graft (STSG), 3 patients with local flaps, and in one patient, because of the superior size of the post-excisional defect, we used local advancement flaps and STSG. In two cases, the histopathological diagnosis revealed fibrosarcomatous differentiation (the largest primary tumor dimension), one of which showed fascial invasion, and both of them received adjuvant radiotherapy. Conclusion: A soft tissue tumor with a clinical appearance suggestive of DFSP, especially in cases of increased tumor sizes, incisional biopsy and subsequent multidisciplinary approach will lead to a wide surgical excision with negative histopathological margins, as a standard treatment, for a lowgrade sarcoma, which rarely metastasizes.</p>","PeriodicalId":520588,"journal":{"name":"Chirurgia (Bucharest, Romania : 1990)","volume":" ","pages":"601-607"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40674409","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":"Feasibility Study of a Variant Procedure of Radical Breast Ductectomy (Dolichectomy) with a Perinipple Incision.","authors":"Stefanos Zervoudis,&nbsp;George Iatrakis,&nbsp;Regis Paulinelli,&nbsp;Panagiotis Tsikouras,&nbsp;Constantine Dimitrakakis,&nbsp;Anastasia Bothou,&nbsp;Iordanis Navrozoglou,&nbsp;Minas Paschopoulos","doi":"10.21614/chirurgia.2783","DOIUrl":"https://doi.org/10.21614/chirurgia.2783","url":null,"abstract":"<p><p>Papillomatosis and recurrent duct ectasia could be treated with terminal lactiferous ducts excision. In this study we describe a modified miniinvasive procedure of terminal lactiferous ducts excision with a perinipple approach to the lower or upper half of the nipple. This technique avoids the much more extensive periareolar incision and has excellent aesthetic results.</p>","PeriodicalId":520588,"journal":{"name":"Chirurgia (Bucharest, Romania : 1990)","volume":" ","pages":"615-618"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40674411","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":"Thyroidectomy for the Management of Differentiated Thyroid Carcinoma and their Outcome on Early Postoperative Complications: A 6-year Single-Centre Retrospective Study.","authors":"Francesk Mulita,&nbsp;Georgios-Ioannis Verras,&nbsp;Vasiliki-Danai Dafnomili,&nbsp;Levan Tchabashvili,&nbsp;Ioannis Perdikaris,&nbsp;Dimitrios Bousis,&nbsp;Elias Liolis,&nbsp;Angelos Samaras,&nbsp;Vasileios Vafeiadis,&nbsp;Angelos Delis,&nbsp;Ioannis Panagiotopoulos,&nbsp;Dimitrios Filis,&nbsp;Panagiotis Perdikaris,&nbsp;Ioannis Maroulis,&nbsp;Stathis Anesidis,&nbsp;Konstantinos Bouchagier","doi":"10.21614/chirurgia.2736","DOIUrl":"https://doi.org/10.21614/chirurgia.2736","url":null,"abstract":"<p><strong>Introduction/objective: </strong>Thyroid carcinoma (TC) accounts for one percent of all carcinomas, with a higher incidence in women. Although there is controversy on the selection of the best surgical treatment for differentiated TC, total thyroidectomy (TT) and subtotal thyroidectomy (STT) are still the two main surgical procedures. The aim of the present study was to evaluate the early complication rates of thyroidectomy in patients undergoing thyroid surgery at a tertiary hospital in Greece.</p><p><strong>Methods: </strong>A total of 306 patients with differentiated TC who underwent thyroid surgery were enrolled retrospectively. Patients were divided into two groups. Group A included 214 patients undergoing TT, whereas 92 patients (group B) underwent STT. Demographic details of patients, operating time, and early complications (hypoparathyroidism, hematoma, infection, temporary recurrent laryngeal nerve palsy) were noted.</p><p><strong>Results: </strong>There was no significant difference in the sex, age, and mean operating time between the two groups (P=0.47, P=0.55, and P=0.09, respectively). Either hematoma or wound infection occurred in 3 (1.4%) or 4 (1.87%) of the patients undergoing TT compared to two (2.17%) or three (3.26%) of the patients undergoing STT (P=0.63 and P=0.46, respectively). In addition, either hypoparathyroidism or temporary recurrent laryngeal nerve palsy was observed in 34 (15.89%) or 13 (6.07%) of the patients undergoing TT compared with eleven (11.96%) or nine (9.78%) of the patients undergoing STT (P=0.37 and P=0.25, respectively).</p><p><strong>Conclusions: </strong>The current study demonstrates that total thyroidectomy can be safely performed in patients with differentiated thyroid carcinoma without increasing the risk of early complications.</p>","PeriodicalId":520588,"journal":{"name":"Chirurgia (Bucharest, Romania : 1990)","volume":" ","pages":"556-562"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40660506","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":"Clinical Diagnosis, Management and Microbiological Profiling of Necrotizing Soft Tissue Infections - A Prospective Study of North India Region.","authors":"Tanya Bhalla,&nbsp;Amandeep Singh Nar,&nbsp;Ravinder Pal Singh,&nbsp;Rohit Jindal,&nbsp;Anuj Bhalla,&nbsp;Atul Mishra","doi":"10.21614/chirurgia.2745","DOIUrl":"https://doi.org/10.21614/chirurgia.2745","url":null,"abstract":"<p><p><b>Background:</b> Necrotizing Soft Tissue Infections (NSTIs) are rapidly progressive, potentially fatal illnesses characterized by necrosis of soft tissue. The disease is highly lethal if left untreated. However, its early diagnosis and management can result in significant decrease in mortality, saving the life of patient and preventing limb loss ; but its diagnosis in early stage is difficult. Therefore, the present work describes a step-by-step protocol for early diagnosis of NSTIs and its application for successful management of NSTIs (type III) in the North Indian population. <b>Methods:</b> This prospective study was conducted over a period of 1 year and 9 months (December 2017 to September, 2019) in a single tertiary center (Dayanand Medical College and Hospital, Ludhiana, Punjab, India) with 115 patients suffering from NSTIs. Demographic, symptomatic and clinical features were recorded. After initial resuscitation, debridement or amputation was done and collected samples were subjected to microbial profiling and drug sensitivity tests. Based on results, suitable pharmacological treatment was started to minimize the risk of mortality and fasten the recovery of patient. <b>Results:</b> The present work showed that in the selected population, monomicrobial gram negative infections are more prominent, more so, among diabetic males. The most prominent pathogen was found to be \"Escherichia coli\" (40% of cases). Enrolled patients had NSTIs in stage 1 and had no blood infection which means they sought medical attention in the early stages of the disease and the clinician was able to detect it. Debridement or amputation resulted in a significant decrease in the mortality rate (10.4%) even when the selected population had lethal Type III NSTIs. Conclusion: The presented approach can aid in early detection and management of NSTIs, thus, helping in saving patient's life and limb.</p>","PeriodicalId":520588,"journal":{"name":"Chirurgia (Bucharest, Romania : 1990)","volume":" ","pages":"572-578"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40660508","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":"A Narrative Review on Bariatric ERAS.","authors":"Niccolò Petrucciani,&nbsp;Cristian Eugeniu Boru,&nbsp;Giulia Lauteri,&nbsp;Gianfranco Silecchia","doi":"10.21614/chirurgia.2754","DOIUrl":"https://doi.org/10.21614/chirurgia.2754","url":null,"abstract":"<p><strong>Introduction: </strong>Bariatric/metabolic surgery (BMS) is the most effective treatment of morbid obesity, while Enhanced Recovery After Surgery (ERAS) after BMS represents a multimodal perioperative protocol designed to achieve early recovery for patients with peculiar characteristics. The aim of the current narrative review is to summarize and discuss the current role, the application, and the future developments of ERAS protocols in the field of BMS.</p><p><strong>Methods: </strong>A literature search for studies published up to June 30, 2022, with no restrictions on language or publication period, was performed on Medline and Embase, using the keywords \"ERAS\" OR \"enhanced recovery after surgery\" AND \"bariatric surgery\" OR \"metabolic surgery\". Postoperative length of hospital stay LOS, overall and major morbidity and mortality, readmission rates, postoperative nausea or vomit PONV, opioids and antiemetics use, hospital costs, ERAS in specific health care settings, barriers to ERAS and further developments were analyzed.</p><p><strong>Results/conclusions: </strong>The results were presented with a narrative review, using tabulation to summarize the results of meta-analyses and RCTs: 6 articles reporting guidelines, 5 metaanalyses, 9 randomized controlled trials, and 48 observational studies. ERAS protocols are feasible and safe in the setting of BMS, and associated to reduced LOS, PONV and postoperative pain, reduced opioid and antiemetic use and reduced costs. Postoperative mortality and readmission rates are similar between patients receiving standard care and those with ERAS protocols. Furthermore, increase of ERAS application may be useful in health care systems dealing with epidemic infectious diseases and implemented by technological advancements.</p>","PeriodicalId":520588,"journal":{"name":"Chirurgia (Bucharest, Romania : 1990)","volume":" ","pages":"505-516"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40660048","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":"Triple Sleeve Bronchial Resection with Total Lung Preservation.","authors":"Adrian Ciuche,&nbsp;Anca-Pati Cucu,&nbsp;Claudiu-Eduard Nistor","doi":"10.21614/chirurgia.2730","DOIUrl":"https://doi.org/10.21614/chirurgia.2730","url":null,"abstract":"<p><p>Triple sleeve bronchial resection with bronchial anastomosis is a complex surgical procedure, more difficult than the standard techniques of bronchial resection and anastomosis, commonly used to treat benign or low-grade malignant neoplasms (such as carcinoid tumours) that are located on the central bronchial axis (primary and lobar bronchi). When performed carefully by a highly trained surgeon, bronchial sleeve resection and reconstruction is a safe and effective surgical procedure. The complete preservation of the lung parenchyma is the main advantage of this surgical technique, along with a radical bronchial tumour resection. Sparing pulmonary function is crucial for both young (to maintain an optimal effort capacity) and elderly patients as well as those with impaired cardiopulmonary function (they may not tolerate lobectomy or pneumonectomy).</p>","PeriodicalId":520588,"journal":{"name":"Chirurgia (Bucharest, Romania : 1990)","volume":" ","pages":"608-614"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40674410","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":"Outcomes of Open Surgery for Retroperitoneal Hematoma in Covid-19 Patients: Experience from a Single Centre.","authors":"Dusan Micic,&nbsp;Krstina Doklestic,&nbsp;Pavle Gregoric,&nbsp;Nenad Ivancevic,&nbsp;Vladimir Arsenijevic,&nbsp;Jelena Milin-Lazovic,&nbsp;Bojana Maricic,&nbsp;Zlatibor Loncar","doi":"10.21614/chirurgia.2763","DOIUrl":"https://doi.org/10.21614/chirurgia.2763","url":null,"abstract":"<p><p><b>Background:</b> Spontaneous retroperitoneal hematoma is a severe and potentially fatal complication that appears in the course of anticoagulation therapy. Therapeutic doses of low molecular weight heparin (LMWH) are used for the prevention of thrombosis in patients seriously ill with Covid-19. <b>Methods:</b> We describe 27 (0.14%) patients with retroperitoneal hematomas who required emergency surgery out of 19108 patients with Covid-19 who were hospitalized in Batajnica COVID Hospital between March 2021 and March 2022. All the patients were on therapeutic doses of LMWH. The existence of retroperitoneal hematoma was confirmed by abdominal ultrasound and computed tomography scans. <b>Results:</b> Open surgery was performed on 27 patients with spontaneous retroperitoneal hematomas (12 female and 15 male). The mean age of the study population was 71.6+-11.9 years. D-dimer was significantly elevated two days before the surgery in comparison with the values on the day of surgery (p=0.011). Six patients (22.23%) survived, while 21 (77.77%) patients died. Conclusion: Bleeding in Covid-19 patients treated by LMWH is associated with an increased risk of developing retroperitoneal hematoma. Open surgery for retroperitoneal hematoma in Covid-19 patients on anticoagulation therapy is a procedure associated with a high rate of mortality.</p>","PeriodicalId":520588,"journal":{"name":"Chirurgia (Bucharest, Romania : 1990)","volume":" ","pages":"526-534"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40660050","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}