CVIR Endovascular最新文献

{"title":"Single-procedure 8Fr rheolytic pharmacomechanical thrombectomy for treatment of acute iliofemoral deep venous thrombosis.","authors":"Nicholas Xiao, Matthew Genet, Rocio Marquez Karry, Elias Hohlastos, Jennifer Karp, Kush Desai","doi":"10.1186/s42155-024-00447-5","DOIUrl":"10.1186/s42155-024-00447-5","url":null,"abstract":"<p><strong>Purpose: </strong>We hypothesize that single-procedure venous-specific rheolytic thrombectomy for treatment of acute iliofemoral deep venous thrombosis (DVT) will result in improved clinical symptoms as measured by the venous clinical severity score (VCSS), as well as durable venous patency, with decreased hemorrhagic risks and costs associated with conventional catheter-directed therapy and prolonged lytic exposure.</p><p><strong>Materials and methods: </strong>Thirty-three consecutive patients with symptomatic, unilateral, iliofemoral DVT who were treated with single-procedure therapy using the 8Fr rheolytic thrombectomy catheter were retrospectively analyzed from 2012-2021. Abstracted data included technical success (> 95% clearance of acute thrombus), adverse events (AEs), and clinical and imaging outcomes at 1-month and 1-year.</p><p><strong>Results: </strong>Technical success was achieved in all 33 patients. Mean pre-procedure VCSS was 7.5 with mean edema and pain sub-scores of 2.6 and 1.8, respectively. Post-procedural total mean VCSS at one month was significantly improved (mean post-procedure VCSS = 0.3, mean reduction of 7.2, P < 0.01). Clinical improvement was sustained at 1-year (mean total VCSS = 0.2, P < 0.01). Primary patency was achieved in all patients at 1-month and 30 (91%) patients at 1-year. Among the 3 patients in which primary patency was not achieved at 1-year, primary-assisted patency was achieved in 2 patients. Secondary patency was achieved in the remaining patient at 1-year. No hemorrhagic AEs occurred in this study.</p><p><strong>Conclusion: </strong>This study suggests that single-procedure venous-specific rheolytic thrombectomy for treatment of acute iliofemoral DVT is safe and effective, resulting in durable clinical and radiographic results at one year, while also limiting hemorrhagic risks, mitigating costs of admission, and expediting patient discharge.</p>","PeriodicalId":52351,"journal":{"name":"CVIR Endovascular","volume":"7 1","pages":"34"},"PeriodicalIF":1.2,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10987403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140338553","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":"Iliocaval and iliofemoral venous stenting for obstruction secondary to tumor compression.","authors":"Ahmed K Aly, Amgad M Moussa, Olivier Chevallier, Sirish Kishore, Elena Petre, Adie Friedman, Yolanda Bryce, Adrian Gonzalez, Juan Camacho, Ernesto Santos, Fourat Ridouani","doi":"10.1186/s42155-024-00438-6","DOIUrl":"10.1186/s42155-024-00438-6","url":null,"abstract":"<p><strong>Background: </strong>Cancer patients with pelviabdominal masses can suffer from lower extremity symptoms due to venous compression. The effectiveness of venous stenting has been established in extrinsic venous compression in benign conditions like May-Thurner syndrome. In this retrospective study we evaluate the efficacy and safety of caval, iliocaval and iliofemoral venous stenting for cases of extrinsic venous compression caused by malignant masses in cancer patients.</p><p><strong>Methods: </strong>IRB-approved retrospective review of patients who underwent iliofemoral venography with venoplasty and stenting between January 2018 and February 2022 was performed. Patients with extrinsic venous compression caused by malignant masses were included. Data on patient demographics, pre-procedure symptoms, procedural technique, stent characteristics, outcomes and follow-up were collected. Descriptive statistics were used to assess technical success, clinical success, primary stent patency and adverse events of the procedure.</p><p><strong>Results: </strong>Thirty-seven patients (19 males, 18 females) who underwent 45 procedures were included. Deep venous thrombosis (DVT) was present in 21 (57%) patients. Twenty-nine patients (78%, 95% CI 62-90%) reported clinical improvement of the presenting symptoms. The median overall survival after the procedure was 4.7 months (95% CI 3.58-5.99). Eight (22%) patients were alive at last follow up with median follow up of 10.33 months (Range 2-25 months). Twenty-six patients had patent stents on their last follow up imaging (70%, 95% CI 61%-91%). Two patients had a small access site hematoma which resolved spontaneously. Two patients developed moderate, and 1 patient developed severe adverse events related to post procedure therapeutic anticoagulation.</p><p><strong>Conclusion: </strong>Venous stenting is a safe procedure and should be considered as part of the palliative care for patients with debilitating lower extremity symptoms related to iliocaval and iliofemoral venous compression.</p>","PeriodicalId":52351,"journal":{"name":"CVIR Endovascular","volume":"7 1","pages":"33"},"PeriodicalIF":1.2,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10957860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140186268","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":"Dealing with complications in interventional radiology.","authors":"A O Oseni, J-Y Chun, R Morgan, L Ratnam","doi":"10.1186/s42155-024-00442-w","DOIUrl":"10.1186/s42155-024-00442-w","url":null,"abstract":"<p><p>It is widely accepted that most misadventures, which lead to harm have not occurred because of a single individual but rather due to a failure of process that results in healthcare workers making mistakes. This failure of process and the pervasiveness of adverse events is just as prevalent in Interventional Radiology (IR) as it is in other specialities. The true prevalence and prevailing aetiology of complications in IR are not exactly known as there is a paucity of investigative literature into this area; especially when compared with other more established disciplines such as Surgery. Some IR procedures have a higher risk profile than others. However, published data suggests that many adverse events in IR are preventable (55-84%) and frequently involve a device related complication such as improper usage or malfunction. This article aims to discuss factors that contribute to complications in IR along with tools and strategies for dealing with them to achieve optimal patient outcomes.</p>","PeriodicalId":52351,"journal":{"name":"CVIR Endovascular","volume":"7 1","pages":"32"},"PeriodicalIF":1.2,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10957835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140186267","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":"Poor short-term outcomes for prognostic high-risk patients with chronic limb-threatening ischemia undergoing endovascular therapy","authors":"Tatsuro Takei, Takashi Kajiya, Norihiko Ohura, Natsuko Tomimura, Takuro Kamiyama, Toshiko Ninomiya, Junichiro Takaoka, Nobuhiko Atsuchi","doi":"10.1186/s42155-024-00443-9","DOIUrl":"https://doi.org/10.1186/s42155-024-00443-9","url":null,"abstract":"The prognosis of chronic limb-threatening ischemia (CLTI) is poor, with an expected life expectancy of 2 or more years, which significantly influences treatment decisions. However, death may occur at the early stages of treatment for wound healing, and aggressive treatment may limit the quality of life of such patients. In patients with CLTI undergoing endovascular therapy (EVT), the Wound, Ischemia, and foot Infection (WIfI) clinical stage, male sex, older age, non-ambulatory status, low body mass index, and dialysis have been reported as predictors of mortality risk. However, most studies have not fully investigated the WIFI clinical stage as a prognostic predictor of CLTI. This study aimed to evaluate short-term prognosis and wound healing rates using the prognostic predictors (PPs) indicated above in risk-stratified patients with CLTI who underwent EVT. This retrospective single-center observational study included 61 CLTI patients undergoing EVT from April 2020 to October 2022. The patients were divided into a high-risk group (PPs ≥ 4, n = 20) and low-risk group (PPs ≤ 3, n = 41) according to the number of PPs. Survival and wound healing rates within one year were compared between these two groups. The mean age of the patients was 74.7 ± 1.6 years, and 42 (68.9%) were male. Among these patients, the high-risk group compared with the low-risk group had a significantly worse survival rate within one year (46.4% vs. 84.7%, log-rank p < 0.001). Fifteen patients died within one year. Of these, seven deaths were cardiovascular deaths and six were deaths from infectious diseases. Cox proportional hazards analysis showed that WIfI clinical stage 4 (p = 0.043, hazard ratio [HR] = 4.85) and the male sex (p = 0.037, HR = 6.34) influenced the prognosis of this population. The high-risk group tended to have a worse wound healing rate within one year than that had by the low-risk group (55.4% vs. 83.0%, log-rank p = 0.086). The assessment of short-term prognosis and wound healing rates using PPs may be useful. Discussing the results of short-term clinical outcome assessments with patients should be considered when determining their individualized treatment plans.","PeriodicalId":52351,"journal":{"name":"CVIR Endovascular","volume":"5 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140172364","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":"Conservative management by embolization of a ruptured renal arterio-venous malformation (AVM) in Hereditary Hemorrhagic Telangiectasia (HHT).","authors":"Romain L'Huillier, Gaële Pagnoux, Sophie Dupuis-Girod, Nicolas Stacoffe","doi":"10.1186/s42155-024-00444-8","DOIUrl":"10.1186/s42155-024-00444-8","url":null,"abstract":"<p><strong>Background: </strong>Renal arteriovenous malformation (AVM) in Hereditary Hemorrhagic Telangiectasia (HHT) is uncommon and only few cases have been described, mainly with surgical management because of uncontrolled hematuria.</p><p><strong>Case presentation: </strong>We managed a 70-year-old patient with HHT who presented with hematuria and left flank pain. Computed Tomography and ultrasound showed left renal AVM of 18 mm with clotting in the urinary tract. An external ureteral catheter was placed during 3 days to allow rinsing and facilitate elimination of clots. Given the patient's hemodynamic stability, a non-surgical management was chosen. Treatment of the AVM was performed by trans-arterial embolization using micro-coils and ethylene-vinyl alcohol copolymer.</p><p><strong>Conclusions: </strong>Our case study shows a conservative management by embolization of ruptured left renal AVM revealed by hematuria in a 70-year-old patient with HHT.</p>","PeriodicalId":52351,"journal":{"name":"CVIR Endovascular","volume":"7 1","pages":"30"},"PeriodicalIF":1.2,"publicationDate":"2024-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10944426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140141149","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":"Rendezvous-PIERCE technique: establishing a channel through severe calcification in infrainguinal arterial lesions using needle rendezvous.","authors":"Takuya Haraguchi, Masanaga Tsujimoto, Yoshifumi Kashima, Katsuhiko Sato, Tsutomu Fujita","doi":"10.1186/s42155-024-00445-7","DOIUrl":"10.1186/s42155-024-00445-7","url":null,"abstract":"<p><strong>Background: </strong>Severe calcification often prevents device passage and balloon expansion in cases of lower extremity artery disease. To address this limitation, we introduced a novel calcium modification technique called Rendezvous-PIERCE (R-PIERCE).</p><p><strong>Methods: </strong>A needle was inserted in a retrograde manner and advanced to touch the tip of an antegrade guidewire within the lesion. Then, the guidewire was advanced into the lumen of the needle to achieve partial guidewire externalization, also known as needle rendezvous. The needle was then introduced over the externalized guidewire under wire tension and repeatedly rotated and advanced across the lesion to modify calcified intimal plaques. Notably, this technique can be applied in the opposite direction.</p><p><strong>Results: </strong>Case 1 involved a 68-year-old male with a calcified occlusion of the anterior tibial artery. An antegrade guidewire reached the midpoint of the occlusion; however, microcatheters and balloons could not pass through the proximal calcification. Therefore, R-PIERCE was used to modify uncrossable lesions. An antegrade 2.5-mm balloon crossed and dilated the lesion, achieving hemostasis at the needle insertion site. The antegrade guidewire successfully crossed the entire lesion and was dilated by the 2.5-mm balloon. Final angiography demonstrated successful flow. In Case 2, an 80-year-old male had a calcified femoropopliteal occlusion. An antegrade guidewire was advanced into the distal superficial femoral artery (SFA); however, no device could follow it. R-PIERCE was performed to modify the calcification from the distal to the medial SFA. The antegrade balloon successfully crossed and dilated obstructed lesions. Furthermore, the antegrade guidewire crossed the entire lesion, and the antegrade balloon was dilated. Final angiography revealed a successful flow without complications.</p><p><strong>Conclusions: </strong>R-PIERCE is useful for modifying complex calcified lesions during the wiring of occlusive lesions.</p>","PeriodicalId":52351,"journal":{"name":"CVIR Endovascular","volume":"7 1","pages":"29"},"PeriodicalIF":1.2,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10942961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140137426","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":"Coil embolization of a giant pseudoaneurysm associated with a disrupted axillary artery: a case report","authors":"Naoki Oka, Akira Kuriyama, Yukio Ishisaka","doi":"10.1186/s42155-023-00408-4","DOIUrl":"https://doi.org/10.1186/s42155-023-00408-4","url":null,"abstract":"Stent-graft placement is generally used to treat pseudoaneurysm (PSA) of the axillary artery (AA) trunk to maintain the patency of peripheral vessels. Coil embolization of a PSA associated with a disrupted AA trunk has rarely been reported. A 54-year-old woman presented with swelling of her right shoulder. She had had a right proximal humeral fracture 12 years earlier. Contrast-enhanced computed tomography (CECT) and subsequent angiograms revealed a giant PSA at the disrupted, distal right AA. There were collateral flows to the brachial artery from the proximal to the right AA. To preserve collateral flows to the brachial artery, selective embolization of the inflow artery that derived from the distal AA was performed with hydrogel-coated coils. The post-embolization arteriogram showed no flow into the PSA, but collateral flows to the brachial artery we preserved. The post-embolization course was uneventful. The patient regained warmth in her right arm and hand on post-embolization day 4. Repeat CECT on post-embolization day 9 confirmed blood-flow to her right radial artery. While a stent-graft should be used if the AA trunk can be preserved, coil embolization should be considered for PSA if the AA trunk is disrupted but collaterals are preserved.","PeriodicalId":52351,"journal":{"name":"CVIR Endovascular","volume":"37 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140097268","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":"In vitro study of the embolic characteristics of imipenem/cilastatin particles","authors":"Hiroki Nakamura, Akira Yamamoto, Takeshi Fukunaga, Hiroyuki Watanabe, Kosuke Ito, Atushi Higaki, Akihiko Kanki, Yoshihiko Fukukura, Tsutomu Tamada","doi":"10.1186/s42155-024-00441-x","DOIUrl":"https://doi.org/10.1186/s42155-024-00441-x","url":null,"abstract":"Imipenem/cilastatin (IPM/CS) has long been administered intravenously as a carbapenem antibiotic. However, since this agent is poorly soluble in liquid, occasional reports have described its use as a short-acting, temporary embolic agent. The purpose of this study was to elucidate the characteristics of IPM/CS particles, which are thought to have pain-relieving effects against osteoarthritis-related pain, as an embolic agent. Three aspects of IPM/CS as an embolic agent were evaluated in vitro: particle size; particle shape; and change in particle size over time. For particle size, the long diameter was measured. Mean particle size (n=244) was 29.2±12.0 µm (range, 1–60 µm). Shape (n=109) was round in 18.35%, elliptical in 11.93%, and polygonal in 69.72%, showing that most particles were polygonal. In observations of changes in particle size over time (n=9), particles had decreased to 75% of their original size at 82±10.7 min, 50% at 89.3±9.14 min, 25% at 91.3±8.74 min, complete dissolved at 91.8±9.02 min. A rapid shrinkage in diameter was seen in the final period. IPM/CS particles are ultrafine and the majority display a polygonal shape. This substance shows ultra-short embolic activity. This study revealed the characteristics of a substance that demonstrates an embolic effect not found in existing embolic materials.","PeriodicalId":52351,"journal":{"name":"CVIR Endovascular","volume":"2015 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140097470","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":"Innovative atherectomy device for treatment of iliac and popliteal lesions in patients with critical ischemic stage of PAOD.","authors":"Giel G Koning, Rüdiger Möller, Ahmed Algharib","doi":"10.1186/s42155-024-00440-y","DOIUrl":"10.1186/s42155-024-00440-y","url":null,"abstract":"","PeriodicalId":52351,"journal":{"name":"CVIR Endovascular","volume":"7 1","pages":"26"},"PeriodicalIF":1.2,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10923769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061249","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":"Validation of the global limb anatomical staging system in Vietnamese patients treated for chronic limb-threatening ischemia.","authors":"Tran Minh Bao Luan, Nguyen Huu Tuong, Tran Ngoc Dang, Do Dang Khoa","doi":"10.1186/s42155-024-00433-x","DOIUrl":"10.1186/s42155-024-00433-x","url":null,"abstract":"<p><strong>Background: </strong>Chronic limb-threatening ischemia (CLTI) is the most severe clinical form of peripheral artery disease (PAD), accounting for approximately 11%, and is strongly associated with the incidence of amputation, cardiovascular events, and mortality. The Global Vascular Guideline (GVG) proposed a new Global Anatomic Staging System (GLASS) for evaluating the anatomic complexity of arterial lesions. However, more research is required to evaluate outcomes after endovascular intervention in CLTI patients using the GLASS.</p><p><strong>Objective: </strong>Our study aimed to describe clinical characteristics, arterial lesions, and endovascular interventions according to three grades of GLASS in the Vietnamese population. We evaluated the technical success, mortality rate, and probability to preserve the limb according to the GLASS.</p><p><strong>Methods: </strong>All patients were diagnosed with CLTI and underwent infrainguinal endovascular intervention at the Department of Thoracic and Vascular Surgery, University Medical Center, Ho Chi Minh City from June 2020 to June 2022. All patients were evaluated before intervention and follow-up at 6 and 12 months after intervention. Patients were divided into three groups according to the GLASS, thereby comparing the technical success, mortality, and amputation rates. This retrospective study describes a series of cases.</p><p><strong>Results: </strong>The study sample evaluated 82 lower limbs of 82 patients, in which GLASS class I, II, and III lesions accounted for 36.6%, 43.9%, and 19.5% of the patients, respectively. The rates of technical success in the groups gradually decreased according to the complexity of the lesions (90%, 86.11%, and 56.25% for GLASS I, II, and III, respectively; p = 0.012). Notably, limb-based patency (LBP) at 12 months was significantly lower in the GLASS III group than in the GLASS I and II groups (22.22% vs 88.89% and 67.74%, respectively; p = 0.001). The amputation rates at 12 months in GLASS groups I, II, and III were 13.3%, 22.2%, and 50%, respectively (p = 0.021), while the mortality rates at 12 months were 0%, 8.33%, and 25%, respectively (p = 0.015).</p><p><strong>Conclusion: </strong>In patients with CLTI of higher GLASS stages, the rates of technical success were lower and the amputation and mortality rates were higher.</p>","PeriodicalId":52351,"journal":{"name":"CVIR Endovascular","volume":"7 1","pages":"25"},"PeriodicalIF":1.2,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10914645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029540","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}