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

{"title":"Oral Plasmablastic Lymphoma: Case Series and Literature Review.","authors":"A Xu, J P Foy, P Reimbold, M Amor-Sahli, A Vozy, I Boussen, A Chaine, M Benassarou, C Bertolus, J Bouaoud","doi":"10.1002/hed.70053","DOIUrl":"https://doi.org/10.1002/hed.70053","url":null,"abstract":"<p><strong>Background: </strong>Plasmablastic lymphoma (PBL) of the oral cavity is a rare, aggressive subtype of Non-Hodgkin lymphoma, predominantly seen in immunocompromised patients, particularly those with chronic Human Immunodeficiency Virus (HIV) infection. This malignancy is closely associated with Epstein-Barr virus (EBV), highlighting its oncogenic role.</p><p><strong>Methods: </strong>We present 11 cases of oral cavity PBL (OPBL) managed at our institution, detailing clinical, radiological, pathological, and therapeutic features, as well as patient outcomes. We also conducted a comprehensive literature review to synthesize current evidence.</p><p><strong>Results: </strong>Since 2008, 645 OPBL cases have been reported. The disease primarily affects men with underlying immunodeficiency, particularly HIV. The maxillary alveolar ridge was the most frequent subsite, typically associated with osteolytic bone lesions. Most patients presented at a localized stage. Although chemotherapy remains the mainstay of treatment, novel targeted therapies are emerging. Prognosis, however, remains poor.</p><p><strong>Conclusions: </strong>OPBL should be systematically considered when evaluating oral cavity malignancy, especially in immunocompromised patients with submucosal lesion.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193956","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":"Postoperative Cosmetic Outcomes and Quality of Life After Thyroidectomy: A Systematic Review and Network Meta-Analysis.","authors":"Van Cuong Nguyen, Chang Myeon Song, Yong Bae Ji, Jin Hyeok Jeong, Jonathon O Russell, Feng-Yu Chiang, Gregory W Randolph, Kyung Tae","doi":"10.1002/hed.70052","DOIUrl":"https://doi.org/10.1002/hed.70052","url":null,"abstract":"<p><strong>Background: </strong>Remote-access thyroidectomy and minimally invasive video-assisted thyroidectomy (MIVAT) were developed to improve cosmesis over the conventional transcervical approach (CTA). However, comparative data on cosmetic and quality of life (QOL) outcomes remain limited.</p><p><strong>Methods: </strong>A systematic review and random-effects network meta-analysis was performed to compare MIVAT, five remote-access approaches-breast approach (BA), bilateral axillo-breast approach (BABA), gasless transaxillary approach (GTAA), retroauricular approach (RA), and transoral approach (TOA)-with CTA.</p><p><strong>Results: </strong>Fifty-seven studies (9206 patients) were included. All remote-access techniques and MIVAT showed superior cosmetic outcomes versus CTA. TOA and BABA ranked highest. Remote-access approaches, particularly TOA, BABA, and GTAA, demonstrated generally better QOL outcomes than CTA and MIVAT.</p><p><strong>Conclusions: </strong>Remote-access approaches and MIVAT offer superior cosmesis over CTA. TOA and BABA generally rank highest in both cosmesis and QOL, although evidence on QOL remains limited. These approaches may be considered for patients prioritizing aesthetic and psychosocial outcomes.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193899","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":"Safety and Efficacy of Vismodegib and Sonidegib in Advanced Basal Cell Carcinoma of the Head and Neck: A Systematic Review and Meta-Analysis.","authors":"Cindy M Doyle, Jevan Cevik, Anand Ramakrishnan","doi":"10.1002/hed.70056","DOIUrl":"https://doi.org/10.1002/hed.70056","url":null,"abstract":"<p><strong>Importance: </strong>Basal cell carcinoma (BCC) is the most prevalent malignancy globally, with 75% occurring in the head and neck. Hedgehog pathway inhibitors (HHIs) may provide a treatment for locally advanced BCC (laBCC) and metastatic BCC (mBCC) of the head and neck.</p><p><strong>Objective: </strong>This systematic review and meta-analysis aimed to evaluate the safety and efficacy of these treatments specifically in the head and neck region.</p><p><strong>Data sources: </strong>An electronic database search was conducted in June 2024 across Embase, MEDLINE, CINAHL, and ClinicalTrials.gov. There were no date limits applied, with search constraints consisting of the English language.</p><p><strong>Study selection: </strong>Included were studies involving adults with confirmed laBCC or mBCC of the head and neck treated with either vismodegib or sonidegib, with histological or radiological confirmation. Studies were excluded if they involved concurrent treatments or lacked quantitative measures. After full text review was completed, there were 17 studies for inclusion.</p><p><strong>Data extraction and synthesis: </strong>This systematic review and meta-analysis were conducted in accordance with PRISMA guidelines using two independent observers. Data extraction was performed using a standardized Microsoft Excel Form. Statistical analyses were conducted using meta-analysis software on jamovi using a random effects model.</p><p><strong>Main outcome(s) and measure(s): </strong>This study initially aimed to investigate both systemic immunotherapies and targeted therapies, but no articles were identified for systemic immunotherapies for laBCC or mBCC of the head and neck region. Thus, the sole focus of this article became targeted therapies. Primary outcomes assessed were overall response rate (ORR), complete response (CR), and partial response (PR), alongside the prevalence of adverse effects.</p><p><strong>Findings: </strong>Seventeen studies involving 522 patients were analyzed, revealing a pooled ORR of 84.2% (95% CI: 77.1-91.3), CR of 33.8%, and PR of 47.7%. Common adverse effects included muscle spasms, dysgeusia, and fatigue, with a discontinuation rate of 13.2% due to adverse events.</p><p><strong>Conclusions and relevance: </strong>This systematic review and meta-analysis demonstrated a high efficacy of vismodegib and sonidegib for treating advanced BCCs in the head and neck region, suggesting a viable option when surgery is not feasible. Further high-quality research is necessary to optimize treatment outcomes for this patient population.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193938","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":"Combined Use of Nonvascularized Iliac Crest Bone Graft and Submental Island Flap in Mandibular Reconstruction: A Technical Note.","authors":"Remzi Dogan, Ramazan Bahadır Küçük, Alper Yenigun, Orhan Ozturan","doi":"10.1002/hed.70055","DOIUrl":"https://doi.org/10.1002/hed.70055","url":null,"abstract":"<p><p>Reconstruction following segmental resection of the mandible due to tumors poses significant aesthetic and functional challenges. While vascularized free tissue flaps remain the gold standard, they are associated with prolonged operative time, high cost, requirement for microsurgical expertise, and donor site morbidity. We present a novel technique combining a nonvascularized iliac crest bone graft (NVICBG) with a submental island flap (SIF) for mandibular reconstruction. Between February 2024 and May 2025, three patients underwent this procedure. Graft and flap survival was achieved in all cases, with satisfactory functional and aesthetic outcomes based on clinical evaluation. Despite the limited sample size, this technique demonstrates promise as a practical and effective alternative, offering a short learning curve, high feasibility, and low complication rates. To our knowledge, this is the first report describing the combined use of NVICBG and SIF for mandibular reconstruction.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187527","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":"Comparison of Outcomes Between Free Ileocolonic and Tube-Shaped ALT Fasciocutaneous Flaps in Total Hypopharyngeal Defect Reconstruction.","authors":"Jian-Xun Chen, Ta-I Wang, Shane D Morrison, Mei-Chen Lin, Pin-Keng Shih","doi":"10.1002/hed.70051","DOIUrl":"https://doi.org/10.1002/hed.70051","url":null,"abstract":"<p><strong>Objectives: </strong>This study compares the outcomes of free ileocolonic and tube-shaped anterolateral thigh (ALT) fasciocutaneous flaps in reconstructing total hypopharyngeal defects.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 76 patients who underwent reconstruction with either an ileocolonic flap (n = 20) or a tube-shaped ALT flap (n = 56) between 2011 and 2021. Primary outcomes included dietary tolerance at 1 and 3 years, pharyngocutaneous fistula rates, and survival. Statistical analyses assessed group differences in complications and dietary restrictions.</p><p><strong>Results: </strong>The ileocolonic flap group demonstrated superior dietary outcomes at 1 and 3 years (90% vs. 62.5% and 90% vs. 51.4%, respectively) but had a higher fistula rate (25% vs. 7.1%, p = 0.048). No significant differences in survival were observed between the groups.</p><p><strong>Conclusion: </strong>The ileocolonic flap offers better long-term dietary outcomes despite higher early fistula rates. Further research is recommended to optimize flap selection for hypopharyngeal reconstruction.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187605","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":"Merkel Cell Carcinoma: Evolving Therapeutics, Continued Challenges.","authors":"Hunter A Holley, Maria Lyons, Barry O'Sullivan, Neville Shine, Robbie Woods, Orla McArdle, James Paul O'Neill","doi":"10.1002/hed.70054","DOIUrl":"https://doi.org/10.1002/hed.70054","url":null,"abstract":"<p><strong>Background: </strong>Merkel Cell Carcinoma (MCC) is a rare, aggressive neuroendocrine malignancy with rising incidence, influenced by ultraviolet (UV) radiation and Merkel cell polyomavirus (MCPyV).</p><p><strong>Methods: </strong>This review summarizes recent advances in MCC management, based on an analysis of current literature, focusing on immune checkpoint inhibitors (ICIs), viral status implications, and evolving multimodal treatment strategies.</p><p><strong>Results: </strong>MCPyV-positive MCC has a median overall survival (OS) of 6.6 years compared to 1.2 years for virus-negative cases. The 5-year OS rate for localized MCC is approximately 50%. Historically, the 5-year OS for metastatic MCC was ~14%, but has significantly improved with ICIs. First-line treatment with avelumab achieved a median OS of 20.3 months and a 5-year OS of approximately 26%. Pembrolizumab demonstrated a median OS of 24.3 months, a median progression-free survival (PFS) of 9.3 months, and a durable response with a median duration of response (DOR) of 39.8 months.</p><p><strong>Conclusion: </strong>Despite advances, MCC recurrence rates remain high (16.4% local, 32.1% regional, 9.5% distant), necessitating vigilant long-term surveillance. Future research should focus on optimizing combination therapies, identifying predictive biomarkers, and refining treatment sequencing to further improve survival and quality of life.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180409","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":"CRISPR Screens Identify PIK3C2A as a Novel Mediator of EGFR Inhibitor Resistance in Head and Neck Squamous Cell Carcinoma.","authors":"Jiayu Wang, Megan L Ludwig, Aditi Kulkarni, Andrew C Birkeland, Nicole L Michmerhuizen, Elizabeth Gensterblum-Miller, Jingyi Zhai, Hui Jiang, Paul Swiecicki, Marisa Buchakjian, Molly Heft Neal, Steven B Chinn, Matthew E Spector, J Chad Brenner","doi":"10.1002/hed.70048","DOIUrl":"https://doi.org/10.1002/hed.70048","url":null,"abstract":"<p><strong>Background: </strong>Head and neck squamous cell carcinoma (HNSCC) is a malignancy with poor prognosis and survival. While epidermal growth factor receptor (EGFR) is a known driver of HNSCC, EGFR inhibitors show limited efficacy as monotherapies, suggesting that effective combination therapies are needed.</p><p><strong>Methods: </strong>We performed GeCKO and Kinase CRISPR library screens to identify candidate knockouts that increase EGFR inhibitor sensitivity in resistant HNSCC cells. We validated a candidate using the CellTiter-Glo viability assay following RNA interference and investigated the mechanisms using apoptosis and cell cycle flow cytometry analysis.</p><p><strong>Results: </strong>Kinase CRISPR library screens identified that PIK3C2A gene downregulation enhanced EGFR inhibitor sensitivity in resistant HNSCC cells. Viability assays further validated that PIK3C2A knockdown overcame EGFR inhibitor resistance in HNSCC cells.</p><p><strong>Conclusions: </strong>Our data suggests that PIK3C2A is a novel mediator of EGFR inhibitor resistance in HNSCC. Future studies are required to determine the mechanisms by which PIK3C2A drives EGFR inhibitor resistance.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126624","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":"Clinical Outcomes of Radiologically Node-Negative Oropharyngeal Squamous Cell Carcinoma: A Retrospective Analysis.","authors":"Mohamed Elmarghani, Panagiotis Asimakopoulos, Mathew Donachie, Rhona Hurley, Mohd Slim, Claire Paterson, Olha Zahranychna, Catriona Douglas","doi":"10.1002/hed.70047","DOIUrl":"https://doi.org/10.1002/hed.70047","url":null,"abstract":"<p><strong>Background: </strong>Oropharyngeal squamous cell carcinoma (OPSCC) shows distinct clinical patterns based on HPV status. In the UK, rising HPV-positive cases have changed the disease's demographics and prognosis. While nodal involvement is a key prognostic factor, a subset presents with radiologically node-negative (N0) disease, where optimal management is unclear. This study examines survival outcomes in these patients, stratified by HPV status.</p><p><strong>Methods: </strong>A retrospective analysis of 1001 OPSCC cases (2012-2020) identified 249 N0 patients. After excluding 39 with unknown HPV status, 210 cases (37% HPV-positive) were analyzed. Demographic, clinical, and treatment data were assessed, with survival analyzed using Kaplan-Meier curves.</p><p><strong>Results: </strong>Overall survival was 56.2%, significantly higher in HPV-positive patients (75.3% vs. 45.1%, p < 0.001). HPV-negative patients had a smaller tumor size, were more often female, with higher smoking, alcohol use, and deprivation. Despite earlier T-stage, they had worse performance scores and received surgery or supportive care more often.</p><p><strong>Discussion: </strong>HPV negative OPSCC retains poor prognosis even in node-negative OPSCC and smaller tumor size on presentation.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076666","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":"Single Port Robot-Assisted Supraclavicular Flap Repair of Iatrogenic Hardware-Associated Pharyngeal Perforation: A Case Report.","authors":"Febronia Morcos Mansour, Mark Marzouk","doi":"10.1002/hed.70041","DOIUrl":"https://doi.org/10.1002/hed.70041","url":null,"abstract":"<p><strong>Background: </strong>The incidence of iatrogenic pharyngeal perforation has been reported to comprise 50%-75% of all pharyngeal perforations. In the context of anterior cervical diskectomy and fusion (ACDF) procedures, pharyngeal perforations are a known, although rare, complication with a morbidity and mortality rate of 4%.</p><p><strong>Methods: </strong>In the following case report, we describe a 19-year-old male who underwent anterior and posterior spinal fusion following a traumatic fall. The patient's clinical course was complicated by persistent infection and hardware failure ultimately leading to a posterior hypopharyngeal perforation. The patient then underwent hyperbaric oxygen therapy followed by a subsequent operation to repair the posterior pharyngeal defect by placing a supraclavicular flap using the single-arm da Vinci robot. Due to the patient's quadriparesis and cervical spine hardware, his neck could not be extended for the operation, and meticulous care was taken to position him properly.</p><p><strong>Results: </strong>Following the robot-assisted operative inset of the supraclavicular flap, the patient resumed hyperbaric oxygen therapy. Flexible nasopharyngoscopy on post-operative Day 3 showed adequate closure of the pharyngeal defect and an intact flap. A barium swallow study completed on post-operative Day 13 confirmed successful closure of the pharyngeal defect.</p><p><strong>Conclusions: </strong>This case report affirms the utility of supraclavicular flaps in the repair of hardware-associated iatrogenic pharyngeal perforation and presents advantageous utilization of the single port da Vinci robot to assist in such operations with complicated exposure and limitations in patient positioning.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071244","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":"Comparing Functional Outcomes Following TORS With Free Flap Reconstruction Using a Radial Forearm vs. Anterolateral Thigh Flap.","authors":"Praneet Kaki, Doreen Lam, Neel R Sangal, Ryan M Carey, Karthik Rajasekaran, Ara Chalian, Robert M Brody, Gregory S Weinstein, Steven B Cannady","doi":"10.1002/hed.70039","DOIUrl":"https://doi.org/10.1002/hed.70039","url":null,"abstract":"<p><strong>Background: </strong>Free flap reconstruction (FFR) following transoral robotic surgery (TORS) is commonly performed using radial forearm free flaps (RFFF). This study compares patterns of functional recovery between RFFFs and anterolateral thigh flaps (ALTFs).</p><p><strong>Methods: </strong>Retrospective cohort study of patients with oropharyngeal cancer who underwent TORS with FFR (2010-2023) at a tertiary care center. A 1:4 ALTF:RFFF propensity score match was performed. Functional Oral Intake Scale (FOIS) assessed outcomes.</p><p><strong>Results: </strong>The 105 patients were included. ALTF patients had lower FOIS at 6 months (3[2.0, 5.0] vs. 5.0[2.0, 6.0], p = 0.045) and 1 year (5.0[2.0, 6.0] vs. 6.0[5.0, 6.8], p = 0.045), with higher PEG tube rates. ALTFs were used for larger defects (62.95 ± 20.25 cm² vs. 51.17 ± 15.11 cm², p = 0.014). Donor site morbidity or postoperative complications were similar between cohorts.</p><p><strong>Conclusions: </strong>ALTFs are suitable for larger defects and lead to slower early functional recovery with higher PEG tube rates compared to RFFFs, with no difference in complications.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056055","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}