Acta Neurochirurgica最新文献

{"title":"Correction to: Night‑time versus daytime surgical outcomes in chronic subdural hematomas: a post hoc analysis of the FINISH randomized trial","authors":"Elias Oulasvirta, Oula Knuutinen, Pihla Tommiska, Riku Kivisaari, Rahul Raj, on behalf of the FINISH study group","doi":"10.1007/s00701-024-06352-z","DOIUrl":"10.1007/s00701-024-06352-z","url":null,"abstract":"","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06352-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142600788","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":"Predisposing factors for incomplete spontaneous recovery after Parsonage-Turner Syndrome","authors":"Alfred P. Yoon, Ellen Y. Lee, Lauren E. Tagliero, Nicholas Pulos, Robert J. Spinner, Allen T. Bishop, Alexander Shin","doi":"10.1007/s00701-024-06350-1","DOIUrl":"10.1007/s00701-024-06350-1","url":null,"abstract":"","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142600756","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":"The prognostic importance of glioblastoma size and shape","authors":"Claes Johnstad,&nbsp;Ingerid Reinertsen,&nbsp;Erik Thurin,&nbsp;Tora Dunås,&nbsp;David Bouget,&nbsp;Lisa M Sagberg,&nbsp;Asgeir S Jakola,&nbsp;Ole Solheim","doi":"10.1007/s00701-024-06351-0","DOIUrl":"10.1007/s00701-024-06351-0","url":null,"abstract":"<div><h3>Purpose</h3><p>Extent of resection, MGMT promoter methylation status, age, functional level, and residual tumor volume are established prognostic factors for overall survival in glioblastoma patients. Preoperative tumor volume has also been investigated, but the results have been inconclusive. We hypothesized that the surface area and the shape were more representative of the tumor’s infiltrative capacities, and thus, the purpose of this study was to assess the prognostic value of tumor size and shape in patients with glioblastoma.</p><h3>Methods</h3><p>In total, 271 patients with primary, unifocal glioblastoma were included from two centers in Norway and Sweden, respectively. All tumors were automatically segmented on preoperative MRI scans and manually validated. Tumor volume was used as a measurement of size, whereas sphericity index and area-to-volume ratio defined the shape complexity of the tumor. Contact surface area of the tumor was considered a measurement of both size and shape. Multivariable Cox proportional hazards models were used to assess the prognostic value of the respective tumor measurements, with previously established prognostic factors as covariates.</p><h3>Results</h3><p>There were no associations between preoperative tumor volume and overall survival. Contact surface area (HR = 1.013, <i>p</i> = 0.002) and sphericity index (HR = 2.223, <i>p</i> = 0.001) were both significant independent prognostic factors for survival in the multivariable Cox models. Contact surface area was also associated with MGMT promoter methylation (<i>p</i> = 0.039) and extent of resection (<i>p</i> = 0.017).</p><h3>Conclusion</h3><p>Tumor shape complexity appears to be an independent prognostic factor in glioblastoma patients and may also be associated with MGMT promoter methylation status and extent of surgical resection.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06351-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142600755","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":"Treatment of adult spine deformity: A retrospective comparison of bone morphogenic protein and bone marrow aspirate with bone allograft","authors":"Oluwatobi O. Onafowokan,&nbsp;Akachimere C. Uzosike,&nbsp;Abhinav Sharma,&nbsp;Matthew Galetta,&nbsp;Nathan Lorentz,&nbsp;Samuel Montgomery,&nbsp;Max R. Fisher,&nbsp;Anthony Yung,&nbsp;Paritash Tahmasebpour,&nbsp;Lauren Seo,&nbsp;Timothy Roberts,&nbsp;Renaud Lafage,&nbsp;Justin Smith,&nbsp;Pawel P. Jankowski,&nbsp;Zeeshan M. Sardar,&nbsp;Christopher I. Shaffrey,&nbsp;Virginie Lafage,&nbsp;Andrew J. Schoenfeld,&nbsp;Peter G. Passias","doi":"10.1007/s00701-024-06346-x","DOIUrl":"10.1007/s00701-024-06346-x","url":null,"abstract":"<div><h3>Background  </h3><p>The use of bone morphogenic protein (BMP-2) in adult spine deformity (ASD) surgery remains controversial more than two decades following its approval for clinical application in spine surgery. This study was performed to assess outcomes in patients undergoing ASD surgery with BMP application compared with a combination of bone marrow aspirate, cancellous bone chips and i-Factor.</p><h3>Methods</h3><p>This was a retrospective cohort study. ASD patients were stratified by use of intra-operative BMP (BMP +) or not (BMA + I) and surveyed for the development of complications and mechanical failure. Quality of life gained following the procedure was evaluated using quality-adjusted life years (QALYs). Cost was calculated using the PearlDiver database and CMS definitions. Multivariable analyses (ANCOVA) and logistic regression were used to adjust for confounding.</p><h3>Results</h3><p>512 patients were included (60% BMP +). At baseline, BMP + patients were older (62.5 vs 60.8 years, <i>p</i> &lt; 0.010). Radiographic and quality-of-life metrics did not differ at follow up timepoints (all p &gt; 0.05). BMP use was associated with higher supplemental rod use (OR: 7.0, 1.9 – 26.2, <i>p</i> = 0.004), greater number of levels fused (OR: 1.1, 1.03 – 1.17, <i>p</i> = 0.003) and greater neurological complications (OR: 5.0, 1.3 – 18.7, <i>p</i> = 0.017). Controlling for rod use and levels fused, BMP use was not associated with a lower risk of mechanical complications (OR 0.3, 95% CI: 0.2 – 3.0, <i>p</i> = 0.353), rod breakage (OR: 3.3, 0.6 – 18.7, <i>p</i> = 0.182) or implant failure (OR: 0.3, 0.04 – 1.51). At 2 years, the BMP + cohort exhibited higher overall costs ($108,062 vs $95,144, <i>p</i> = 0.002), comparable QALYs (0.163 vs 0.171, <i>p</i> = 0.65) and higher cost per QALY (<i>p</i> = 0.001) at two years.</p><h3>Conclusions</h3><p>In this analysis, BMP-2 application was not associated with superior outcomes when compared to a less costly biologic alternative (bone marrow aspirate + cancellous bone chips + i-Factor) following ASD surgery. The use of BMP-2 in ASD surgery appears to have reduced cost-efficacy at two years postoperatively.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142598824","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":"Comparative analysis of 333 proGAV® and proGAV 2.0® adjustable valves in pediatric hydrocephalus treatment: survival and complication rate assessment","authors":"Mohammed Issa,&nbsp;Filippo Paggetti,&nbsp;Clara Dannehl,&nbsp;Nieke Ueding,&nbsp;Sandro M. Krieg,&nbsp;Ahmed El Damaty","doi":"10.1007/s00701-024-06348-9","DOIUrl":"10.1007/s00701-024-06348-9","url":null,"abstract":"<div><h3>Objective</h3><p>ProGAV and ProGAV2.0 adjustable valves are extensively used for treating hydrocephalus in pediatric patients. This study aims to conduct a comprehensive comparison between these two valves concerning their survival and complication rates.</p><h3>Methods</h3><p>This retrospective study included all pediatric patients who underwent ProGAV or ProGAV2.0 valve implantation at our neurosurgical clinic from August 2008 to August 2020. A comparative analysis was performed considering age, gender, follow-up duration, complication and survival rates, adjustments, spontaneous adjustments, and adjustment difficulty rates. All valves were followed up for a maximum of 3 years.</p><h3>Results</h3><p>Inclusion involved 333 cases (mean age of 5.4 ± 5.1 years; 54.1% males), comprising 173 cases (52.0%) with ProGAV valve implantation and 160 cases (48.0%) with ProGAV 2.0. Early complications within the first month post-implantation were observed in 51 cases (15.3%). No significant differences were noted in valve implantation indications, age distribution, or survival duration (27.1 vs. 27.8 months, p = 0.629) between the two groups. Predominant indications for implantation were post-hemorrhagic hydrocephalus and aqueduct stenosis for both valve types. Notably, both valves showed non-significantly different explantation rates during the first three years after implantation (34.7% vs. 29.7%, <i>p</i> &lt; 0.289). However, there was a significantly higher early post-implantation complication rate (22% vs. 9.4%, <b><i>p</i></b><b> = 0.002</b>), and a significantly increased association with difficulties in valve adjustments and spontaneous adjustments (<b><i>p</i></b><b> = 0.041 and 0.011</b>, respectively). ProGAV2.0 cases displayed notably enhanced clinical and radiological improvement within the initial 6 months after implantation (<b><i>p</i></b><b> = 0.001 and p = 0.038</b>). Younger children (&lt; 2 years of age) also experienced significantly more valve adjustment difficulties (<i>p</i> = <b>0.049</b>) and had higher rates of valve explantation (<b><i>p</i></b><b> &lt; 0.001</b>).</p><h3>Conclusion</h3><p>The findings of this study highlight the superior performance of the ProGAV2.0 valve in terms of complication rate and maladjustment rate when employed in the treatment of pediatric hydrocephalus. Both valves demonstrated an acceptable survival rate with 65.3% for ProGAV and 71.3% for ProGAV2.0 within three years of implantation.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06348-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142596020","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":"How I do it - endoscopic endonasal optic nerve decompression for traumatic optic nerve neuropathy","authors":"Antonio Strangio,&nbsp;Jean-Michel Bourque,&nbsp;Martin Côté,&nbsp;Pierre-Olivier Champagne","doi":"10.1007/s00701-024-06347-w","DOIUrl":"10.1007/s00701-024-06347-w","url":null,"abstract":"<div><p>Traumatic optic neuropathy (TON) consists of damage to the optic nerve following head injury and affects about 0.5–5% of patients with closed head injuries. It is characterized by a sudden decrease in visual acuity and/or visual field loss. Surgical treatment is usually warranted when ongoing compression occurs at the level of the optic canal. We describe the technical nuances of endoscopic endonasal approach for compressive TON and add evidence supporting this approach as a valid option to treat this condition.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142595308","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":"Utilizing retinal arteriole/venule ratio to estimate intracranial pressure","authors":"Mathias Just Nortvig,&nbsp;Mikkel Christian Schou Andersen,&nbsp;Niclas Lynge Eriksen,&nbsp;Jan Saip Aunan-Diop,&nbsp;Christian Bonde Pedersen,&nbsp;Frantz Rom Poulsen","doi":"10.1007/s00701-024-06343-0","DOIUrl":"10.1007/s00701-024-06343-0","url":null,"abstract":"<div><h3>Purpose</h3><p>Intracranial pressure (ICP) control is important to avoid secondary brain injury in patients with intracranial pathologies. Current methods for measuring ICP are invasive and carry risks of infection and hemorrhage. Previously we found correlation between ICP and the arteriole-venous ratio (A/V ratio) of retinal vessels in an outpatient setting. This study investigated the usability of fundoscopy for non-invasive ICP estimation with the addition of intraocular pressure (IOP) in patients in a neuro-intensive care unit (NICU).</p><h3>Methods</h3><p>This single-center prospective cohort study was conducted at the NICU of Odense University Hospital from September 2020 to May 2021. Adult patients with a Glasgow Coma Score of 8 or less, who underwent invasive pressure neuromonitoring were included. Fundoscopy videos were captured daily and analyzed using deep learning algorithms. The A/V ratio was calculated and correlated with ICP. The data was analyzed using mixed-effect linear regression models.</p><h3>Results</h3><p>Forty patients were enrolled. Fifteen were included in the final analysis. ICP ranged from -1 to 31 mmHg (mean: 10.9, SD: 5.7), and IOP ranged from 4 to 13 mmHg (mean: 7.4, SD: 2.1). The A/V ratio showed a significant negative correlation with ICP &gt; 15 mmHg (regression slope: -0.0659, 95%-CI: [-0.0665;-0.0653], p &lt; 0.001). No significant change in A/V ratio was observed for ICP ≤ 15 mmHg. A similar significant correlation was found for ICP &gt; IOP (regression slope: -0.0055, 95%-CI: [-0.0062;-0.0048], p &lt; 0.001). Taking the IOP into account did not improve the model. The sensitivity analysis showed a sensitivity of 80.08% and a specificity of 22.51%, with an AUC of 0.6389.</p><h3>Conclusion</h3><p>In line with our previous work, non-invasive fundoscopy is a potential tool for detecting elevated ICP. However, challenges such as image quality and diagnostic specificity remains. Further research with larger, multi-center studies are needed to validate the utility. Standardization may enhance the technique's clinical applicability.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06343-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142595307","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":"How I do it: MRI-guided stereotactic navigation for Laser Interstitial Thermal Therapy","authors":"Rune Rasmussen,&nbsp;Silas Haahr Nielsen","doi":"10.1007/s00701-024-06335-0","DOIUrl":"10.1007/s00701-024-06335-0","url":null,"abstract":"<div><h3>Background</h3><p>MR-guided stereotaxy has emerged as a viable alternative to CT-guided frame-based or frameless approaches. By offering direct MR-guided navigation, this technique addresses most limitations inherent to CT navigation, enabling submillimeter precision.</p><h3>Method</h3><p>We detail the workflow of using the ClearPoint® MR navigation system for laser catheter placement in the treatment of a hypothalamic hamartoma.</p><h3>Conclusion</h3><p>MR-guided navigation is a precise and effective stereotactic method for laser ablation of targets with high demands for accuracy. However, compared to standard stereotactic techniques, MR-guided navigation is more time-consuming and costly.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142595354","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":"The impact of early surgery on mortality and functional recovery in older adults with traumatic intracranial lesions: a propensity score-based analysis","authors":"Ana M Castaño-Leon,&nbsp;Pedro A Gomez,&nbsp;Luis Jimenez-Roldan,&nbsp;Igor Paredes,&nbsp;Pablo M Munarriz,&nbsp;Juan Delgado-Fernandez,&nbsp;Irene Panero Perez,&nbsp;Luis Miguel Moreno Gomez,&nbsp;Olga Esteban Sinovas,&nbsp;Guillermo Garcia Posadas,&nbsp;Monica Maldonado Luna,&nbsp;Andreea Enmanuela Baciu,&nbsp;Alfonso Lagares","doi":"10.1007/s00701-024-06324-3","DOIUrl":"10.1007/s00701-024-06324-3","url":null,"abstract":"<div><h3>Background</h3><p>There is skepticism about the benefit of surgery in elderly patients affected by traumatic brain injury (TBI) due to the negative effect of age on the outcome and surgical complications. However, there are few studies that have investigated differences in patient’s outcome between surgically and conservatively managed patients after adjusting for the imbalance in preinjury characteristics and clinical and radiological features. The primary aim of this study was to evaluate the effect of early surgery on mortality and functional recovery in a cohort of older adults with acute traumatic intracranial lesions after adjustment by Propensity Score (PS) matching.    </p><h3>Materials and methods</h3><p>We conducted a retrospective cohort study on older adult patients (≥ 65 years) admitted for TBI between 2013 and 2023 to a single level 1 trauma center. Patients were categorized based on whether they underwent early surgery (&lt; 48 h after TBI) for a space-occupying lesion evacuation. PS model was constructed based on age, frailty, comorbidities (Charlson comorbity index and American Society of Anaesthesiologists score), anticoagulants, hypoxia, shock, pupillary abnormalities and GCS motor response upon admission, midline shift, basal cistern effacement, volume of subdural and intracerebral hematomas, and limitation of life-sustaining treatment decisions.The effect of early surgery on 30-day mortality and unfavorable functional outcomes (GOSE 1–3) at 6 and 12 months were investigated after matching by paired test.</p><h3>Results</h3><p>We identified and reviewed 301 patients who met all inclusion criteria and contained no exclusions. After matching, 62 patients (31 pairs of conservative and surgical patients) remained as the matched datasets. Our key finding was that older adult TBI patients who underwent early surgery had a statistically significant reduction in the risk of 30-day mortality (OR 0.313, 95% CI 0.114–0.853, <i>p</i> = 0.023) and unfaourable outcome at 12 months after TBI (OR 0.286, 95% CI 0.094–0.868, <i>p</i> = 0.027).</p><h3>Conclusions</h3><p>Early surgery was associated with decreased 30-day mortality and better functional outcome at 12 months after TBI in older adults with few comorbidities and good functionality when clinically affected by acute traumatic intracranial lesions with mass effect.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581095","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":"Case report: thrombectomy for left internal carotid artery occlusion with ipsilateral dual accessory middle cerebral arteries","authors":"Jota Tega,&nbsp;Yoshinobu Horio,&nbsp;Koichiro Suzuki,&nbsp;Yuta Oka,&nbsp;Koichiro Takemoto,&nbsp;Hiroshi Abe","doi":"10.1007/s00701-024-06338-x","DOIUrl":"10.1007/s00701-024-06338-x","url":null,"abstract":"<div><p>Accessory middle cerebral arteries (AMCAs) are found in 0.3–4.0% of cases, and ipsilateral dual AMCAs are rare. A seventy-three-year-old man presented with right hemiplegia and total aphasia. Magnetic resonance angiography showed left carotid artery occlusion. We infused him with tissue plasminogen activator. Digital subtraction angiogram showed revascularization of the left internal carotid artery. However, the left proximal anterior cerebral artery was occluded. We performed mechanical thrombectomy and achieved partial reperfusion. CT angiography on the tenth day showed ipsilateral dual AMCAs. Due to middle cerebral artery anomalies, we performed mechanical thrombectomy using contact aspiration which is safer than other techniques. </p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581094","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}