Head and Neck-Journal for the Sciences and Specialties of the Head and Neck最新文献

{"title":"Use of the Superior Thyroid Artery as a Recipient Artery in Head and Neck Free Flap Reconstruction: Effects on Post-Operative Hypothyroidism.","authors":"Kaitlynne Y Pak, Alberto Nunez, Harsh Patel, Allen S Ho, Jon Mallen-St Clair","doi":"10.1002/hed.28049","DOIUrl":"https://doi.org/10.1002/hed.28049","url":null,"abstract":"<p><strong>Background: </strong>The superior thyroid artery (STA) as a recipient vessel in free flap reconstruction may theoretically impact thyroid function. This study aimed to assess whether the use of the STA has an adverse effect on thyroid function.</p><p><strong>Methods: </strong>Retrospective review of 101 head and neck reconstructive cases. Thyroid function tests were reviewed within 1 year of surgery.</p><p><strong>Results: </strong>The STA was used in 40 cases. The STA cohort had significantly higher TSH levels than the non-STA cohort (7.34 v. 2.87 mU/L, p = 0.02). About 27.5% developed subclinical post-operative hypothyroidism and 17.5% required new levothyroxine supplementation in the STA group.</p><p><strong>Conclusion: </strong>This represents the first study to our knowledge assessing the impact of the STA as a recipient vessel on postoperative thyroid function. While we found a statistically significant difference in average TSH after using the STA, the average TSH/FT4 values were subclinical. Post-operative monitoring for hypothyroidism is warranted in this population.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dedifferentiation of a Chondrosarcoma of the Larynx: A Case Report.","authors":"Steven J Charous, Brian Yuhan, Kerstin M Stenson, Vidit Talati, Phillip McMullen","doi":"10.1002/hed.28004","DOIUrl":"https://doi.org/10.1002/hed.28004","url":null,"abstract":"<p><strong>Background: </strong>Chondrosarcomas of the larynx, relatively rare tumors with low grade pathology in approximately 95% of cases, can most often be managed with conservation laryngeal procedures. Dedifferentiated chondrosarcomas are much more rare and aggressive requiring more aggressive surgical extirpation.</p><p><strong>Methods: </strong>A patient underwent three debulking procedures for a laryngeal chondrosarcoma Grade I/II histologically over a 2.5 year period of time during which slow growth was closely monitored. He then presented with relatively rapid onset of hoarseness and shortness of breath. Fiberoptic laryngoscopy demonstrated new bilateral vocal fold fixation with near occlusion of his subglottis by soft tissue mass.</p><p><strong>Results: </strong>A total laryngectomy was performed that pathologically demonstrated a Grade III dedifferentiated chondrosarcoma. Shortly thereafter, the patient developed regional metastases, then distant metastases and then succumbed to the disease.</p><p><strong>Conclusion: </strong>This first case of a Grade III dedifferentiating chondrosarcoma arising from closely monitored and multiple debulked previously Grade I/II tumor demonstrates the potential change in aggressiveness in low-grade chondrosarcomas of the larynx. Sudden increase in growth along with a soft tissue component to the tumor based on exam and/or imaging should heighten suspicion for dedifferentiation of the tumor and necessitates a more aggressive surgical resection. However, the chance of cure once dedifferentiation occurs is drastically reduced.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost Outcomes of Virtual Surgical Planning in Head and Neck Reconstruction: A Systematic Review","authors":"Jenny B. Xiao,&nbsp;Norbert Banyi,&nbsp;Khanh Linh Tran,&nbsp;Eitan Prisman","doi":"10.1002/hed.28035","DOIUrl":"10.1002/hed.28035","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Virtual surgical planning (VSP) is an emerging method in head and neck reconstruction with demonstrated benefits, however, its economic viability is supported with mixed evidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A structured search was performed in five electronic databases. Studies that performed an economic evaluation on VSP in head and neck reconstruction were included. Data regarding VSP workflow, costs, and variables influencing costs were recorded and synthesized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighteen studies met the final inclusion criteria (<i>n</i> = 733). Fourteen out of 18 studies (78%) found that VSP either generated cost savings or was comparable to freehand surgery (FHS). The majority of cost savings were generated from reduced OR times and LOS/LOH. In addition, greater cost savings were associated with in-house VSP workflows compared to those that are outsourced.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>VSP is potentially cost-beneficial compared to traditional unplanned surgery, however, substantial heterogeneity amongst methods and outcome measures impedes the generalizability of these findings.</p>\u0000 \u0000 <p>\u0000 <b>Trial Registration:</b> PROSPERO: CRD42024504398</p>\u0000 </section>\u0000 </div>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":"47 3","pages":"1037-1057"},"PeriodicalIF":2.3,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hed.28035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant Intensity Modulated Radiation Therapy With a Pedicled Flap Reconstruction in Oral Cavity Squamous Cell Carcinomas: Implications on Target Delineation.","authors":"Sarbani Ghosh Laskar, Shwetabh Sinha, Pritha Roy, Rabi Das, Shivakumar Thigarajan, Anuj Kumar, Samarpita Mohanty, Ashwini Budrukkar, Monali Swain, Devendra Chaukar, Gouri Pantvaidya, Anuja Deshmukh, Prathamesh Pai, Deepa Nair, Sudhir Nair, Poonam Joshi, Rathan Shetty, Arjun Singh, Vidisha Tuljapurkar, Richa Vaish, Pankaj Chaturvedi","doi":"10.1002/hed.28056","DOIUrl":"https://doi.org/10.1002/hed.28056","url":null,"abstract":"<p><strong>Objectives: </strong>To address controversies regarding target volume delineation for adjuvant intensity-modulated radiation therapy for oral cavity squamous cell carcinoma with pedicled flap reconstruction and elective nodal irradiation (ENI).</p><p><strong>Materials and methods: </strong>During target volume delineation, the primary tumor bed was the pre-surgical gross tumor volume with an additional isotropic margin of 5-10 mm. Additionally, the flap and body tissue junction were given a margin of 5-10 mm (if not already given). An effort was not made to trace the flap for inclusion in the clinical target volume (CTV), except when it traversed through the involved nodal regions. Contralateral ENI was carried out only in tumors crossing the midline when there was a heavy nodal burden at Ia/Ib.</p><p><strong>Results: </strong>In the 143 patients analyzed, the most common sub-site was buccal mucosa (78, 54.5%). Contralateral ENI was done in 63 patients (36 Tongue, 23 Buccoalveolar). The median follow-up of surviving patients was 24 months. The 2-year Locoregional Control, Disease-Free Survival, and Overall Survival were 77.4%, 64.5%, and 79% respectively. Overall, there were 55 (38.5%) recurrences, of which 35 (24.5%) were either local, regional, or combined locoregional failures, 13 (9.1%) were distant failures alone, and 7 (4.9%) had both locoregional and distant failures. The elective nodal regions had 3 (2.1%) contralateral nodal failures.</p><p><strong>Conclusion: </strong>The entire flap need not be intentionally covered in the target volume. Contralateral ENI should be considered only for patients with heavy nodal burden at ipsilateral level Ia/Ib, in tumors crossing the midline, or in tumors having a high propensity for contralateral lymph nodal involvement.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Radical Radiotherapy (RT) or Chemoradiotherapy (CRT) in Surgically Inoperable Advanced Oral Cavity Cancer: A Single Center Experience.","authors":"Shashank Shenoy, Ankita Mallick, Sudipta Pati, Sanjoy Chatterjee, Indranil Mallick","doi":"10.1002/hed.28055","DOIUrl":"https://doi.org/10.1002/hed.28055","url":null,"abstract":"<p><strong>Background: </strong>Patients with locally advanced, surgically unresectable oral squamous cell cancers (SU-OSCC) are often treated with palliative intent. There is limited information on the outcomes of radical intent treatment with radiotherapy (RT) or chemoradiotherapy (CRT).</p><p><strong>Methods: </strong>We retrospectively examined patients with Stage III/IV previously untreated SU-OSCC treated definitively from 2011 to 2021 in a single institution with RT or CRT with or without neoadjuvant chemotherapy (NACT).</p><p><strong>Results: </strong>Sixty-nine patients met the inclusion criteria. Oral tongue (38%) and buccal mucosa (32%) were the commonest subsites. T4a, T4b, and N2-3 disease were present in 28 (40.6%), 26 (37.7%), and 39 (56.5%) patients, respectively. Median OS and PFS of the whole group were 16 months and 10 months. The 2-year loco-regional control was 60.4%. Bone involvement or NACT use did not affect outcomes.</p><p><strong>Conclusions: </strong>Upfront radical RT/CRT in patients with SU-OSCC with good performance status results in good outcomes and should be preferred to a palliative approach.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Dental Implant Success: A Systematic Review and Meta-Analysis of Primary Versus Secondary Implantation in Free Bone Flap Reconstruction for Malignant Tumors","authors":"Sophie Dugast,&nbsp;Julie Longis,&nbsp;Marine Anquetil,&nbsp;Pierre Corre,&nbsp;Svetlana Komarova,&nbsp;Hélios Bertin","doi":"10.1002/hed.28059","DOIUrl":"10.1002/hed.28059","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Dental implantation of bone reconstructions in oncologic situations improves patients' orofacial function and quality of life. There are currently no recommendations on the timing of implantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This systematic review with meta-analysis aimed to compare primary and secondary dental implantation of free bone flaps in reconstructions for malignant tumors of the oral cavity. The primary objective was to evaluate the implant survival rate, with secondary criteria including time to prosthesis placement, postoperative complications, and data on quality of life. Results—Three databases were screened for articles published between January 1990 and April 2024. Out of 2438 studies, 16 met the eligibility criteria, encompassing 284 patients. In total, 319 implants were placed in the primary implantation group and 1108 in the second group. Implant survival rate was 92.5% in the primary implantation group compared to 88.5% in the secondary implantation group. This systematic review underscores a higher success rate for implants placed primarily in patients with oral cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Given the rapid functional and aesthetic improvement offered by prosthetic rehabilitation, primary implantation should be systematically considered in the oncological population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":"47 4","pages":"1277-1290"},"PeriodicalIF":2.3,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geriatric Nutritional Risk Index and Postoperative Outcomes Following Head and Neck Cancer Surgery.","authors":"Praneet C Kaki, Aman M Patel, Jason A Brant, Steven B Cannady, Karthik Rajasekaran, Robert M Brody, Ryan M Carey","doi":"10.1002/hed.28052","DOIUrl":"https://doi.org/10.1002/hed.28052","url":null,"abstract":"<p><strong>Background: </strong>The geriatric nutritional risk index (GNRI) is a tool to assess preoperative nutritional status that can be calculated simply based on height, weight, and serum albumin. This study assesses the utility of GNRI in predicting postoperative complications in patients undergoing major head and neck cancer (HNC) surgery.</p><p><strong>Methods: </strong>Retrospective review of the 2016-2020 National Surgical Quality Improvement Program database. Patients were categorized into GNRI > 98 (normal nutritional status), GNRI 92-98 (moderate malnutrition status), and GNRI < 92 (severe malnutrition status). Univariable and multivariable binary logistic regression analyses were performed.</p><p><strong>Results: </strong>Sixteen thousand seven hundred eight-nine patients undergoing HNC resection were included. On multivariable analysis, moderate and severe malnourishment based on GNRI remained significantly associated with any surgical complication, any medical complication, any complication, Clavien-Dindo grade IV complications, and 30-day mortality.</p><p><strong>Conclusions: </strong>GNRI may have utility as a potentially modifiable preoperative prognostic factor that can be optimized to improve complications and mortality following HNC resection.</p><p><strong>Level of evidence: </strong>Level 4.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Submandibular Gland Flap Reconstruction for Oropharyngeal Defects After Transoral Robotic Surgery (TORS).","authors":"Daniel P Lander, Nikhil Vettikattu, Tuleen Sawaf, Naomi Wang, Mihir R Patel, Azeem S Kaka, Andrés M Bur, Ryan S Jackson","doi":"10.1002/hed.28051","DOIUrl":"https://doi.org/10.1002/hed.28051","url":null,"abstract":"<p><strong>Background: </strong>To describe utilization and outcomes of submandibular gland flap (SGF) reconstruction after transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC).</p><p><strong>Methods: </strong>A multi-institutional retrospective case series of patients who underwent TORS for OPSCC followed by SGF reconstruction with harvest via transcervical approach from 1/1/2016 to 4/1/2023.</p><p><strong>Results: </strong>In total, 14 patients underwent SGF reconstruction after TORS for OPSCC. All patients had HPV-positive disease, predominantly in early local (N = 10 with pT1/pT2 disease, 71%) and regional stages (N = 11 with pN0/pN1 disease, 79%). Most patients received adjuvant radiation treatment (N = 9, 64%). Median hospital LOS after surgery was 4 days (IQR 2 days) with median functional oral intake scale (FOIS) score of 5 (IQR 0.8) at 1-3 weeks after surgery.</p><p><strong>Conclusions: </strong>SGF reconstruction is a useful technique for closure of appropriately selected TORS defects requiring reconstruction beyond healing by secondary intention and mobilization of adjacent tissue but not large enough to warrant free flap reconstruction.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postauricular Approach for Enucleation of Cervical Vagal Schwannomas.","authors":"Jong-Lyel Roh","doi":"10.1002/hed.28053","DOIUrl":"https://doi.org/10.1002/hed.28053","url":null,"abstract":"<p><strong>Background: </strong>This study evaluates the outcomes of intracapsular enucleation using the retroauricular hairline incision (RAHI) approach for treating cervical vagal schwannomas.</p><p><strong>Methods: </strong>A longitudinal study was conducted on patients with cervical vagal schwannomas. Eleven patients who underwent RAHI-based enucleation were included. Preoperative imaging was performed using contrast-enhanced MRI. Postoperative evaluations assessed pain, neurological function, cosmetic outcomes, voice, and swallowing functions.</p><p><strong>Results: </strong>Eleven patients underwent surgery. The median tumor size was 4.6 cm. The median operation time was 42 min, with minimal bleeding. Common complications were earlobe numbness (45%) and temporary vocal cord paralysis (27%), which were resolved within a year. Cosmetic satisfaction was high, with median VAS scores of nine for scars and 10 for facial deformities. No significant dysphagia was found. No recurrences were observed over a median follow-up of 79 months.</p><p><strong>Conclusions: </strong>Intracapsular enucleation using the RAHI approach is a safe and effective method for treating cervical vagal schwannomas.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On TRacK With Larotrectinib in a Neonate With a Giant Congenital ETV6::NTRK3 Fusion-Positive Infantile Fibrosarcoma of the Head and Neck.","authors":"Teresa M Cardesa-Salzmann, Monika Sparber-Sauer, Peter Hingst, Andreas Erbersdobler, Bjoern Schneider, Maja Hühns, Andre Jakob, Friederike Terpe, Christian Spang, Dorothea Stalmann, Claudia Bierwirth, Christina Hauenstein, Stefanie Märzheuser, Manfred Ballmann, Carl Friedrich Classen","doi":"10.1002/hed.28058","DOIUrl":"https://doi.org/10.1002/hed.28058","url":null,"abstract":"<p><strong>Background: </strong>Infantile fibrosarcoma (IFS) is a rare pediatric tumor of intermediate malignancy with high local aggressiveness that typically presents in young infants. Its occurrence in the head and neck region is rare. Complete non-mutilating surgical resection is often not possible, requiring multimodal treatment. IFS frequently harbors neurotrophic receptor tyrosine kinase (NTRK) fusions. Targeted therapy with NTRK inhibitors is modifying treatment paradigms of IFS.</p><p><strong>Methods: </strong>Herein, we report the case of a neonate with a giant unresectable congenital ETV6::NTRK3 (+) IFS of the head and neck region without rapid response to chemotherapy who was treated with larotrectinib oral suspension.</p><p><strong>Results: </strong>Larotrectinib was well tolerated and induced an impressive clinical and radiologic response.</p><p><strong>Conclusions: </strong>This case illustrates an example of pediatric precision oncology in a neonate with an ETV6::NTRK3 (+) congenital IFS of the head and neck region and provides further reference for the use of larotrectinib in the neonatal period.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}