Journal of medical research and surgery最新文献

{"title":"Zinc(II) Induced Alzheimer’s Disease Prevention and Progression With Early, Middle and Lately Stages","authors":"Tsuneo Ishida","doi":"10.52916/jmrs244142","DOIUrl":"https://doi.org/10.52916/jmrs244142","url":null,"abstract":"Zinc(Ⅱ) induced Alzheimer’s Disease (AD) prevention and suppressive progression with early, middle, and lately stages are elucidated, and subsequently zinc binding molecular mechanism on each Aβ peptide and Tau protein in progressing stages is clarified. Zinc homeostasis regulates MCI and AD prevention, in which ZnCl2 could prevent AD pathology by that zinc can reduce β-Amyloid (Aβ) and Tau proteins. Zinc transporters may allow the novel therapies that ZnT-6 functions to a likely site of Aβ generation. At AD progression with early stage, zinc-induced aggregation of Aβ peptides and tau hyperphosphorylation on amyloid and tau aggregation consider the involvement of environmental zinc in Aβ and tau pathology. Zinc can suppress spreading of the Aβ peptide and the Tau protein that elemental zinc 150 mg daily is showed to be evident for an improvement of memory, understanding, communication, and social contact in AD. Zinc induced middle stage AD progression is pathologically characterized by the deposition of Aβ plaques and hyperphosphorylated Tau Proteins (p-tau). Zinc Finger Proteins (ZNFs) regulate the accumulation of tau proteins to affect the Neurofibrillary Tangles (NFTs), resulting in the formation of NFTs, and can inhibit protein phosphatase, promoted abnormal phosphorylation of tau protein. Zinc(Ⅱ) can prevent heavy stage AD with pathological deposits of Senile Plaques (SPs) and NFTs that the tau-zinc interaction will help understanding the zinc-related tau regulation or aggregation processes in both physiological and pathological conditions. Zinc accelerates the fibrillization of human Tau and thereby increases Tau toxicity in neuronal cells with zinc exacerbated tauopathic deficits. Zinc induced toxic Reactive Oxygen Species (ROS) generation and hyperphosphorylated tau cause oxidative stress and neurotoxicity, leading to hyperphosphorylated tau damages. Zinc(Ⅱ) binding AD molecular mechanism on Aβ and Tau proteins is that Zn2+ ions which having Zn2+ ions-centered tetrahedral geometric coordination pattern and Zn-CysHis Ligands complexes with tetrahedral geometry formed, bind with Aβ and Tau proteins in each three AD progressing stages, causing Zn2+ ions-each stages protein complex formations and oxidative stress to Aβ and Tau protein cells, leading the Zn-CysHis Ligands complexes to molecular and apoptosis activities of synaptic cells.","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141831646","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":"Diagnostic Accuracy of Combined Mammography and Ultrasound in the Detection of Malignant Breast Lesions Using Bi-RADS Classification Taking Histopathology as the Gold Standard","authors":"Anum Sultan, Syeda Zehra Rizvi, Dania Cioni, Emanuele Neri","doi":"10.52916/jmrs244137","DOIUrl":"https://doi.org/10.52916/jmrs244137","url":null,"abstract":"Introduction: Breast cancer is the leading cause of cancer in women with an estimated 2.3 million new cases worldwide and a high mortality rate. The incidence of breast cancer has been increasing worldwide in the past few years with a similar trend of escalation in Pakistan. The age-standardized incidence rate of breast cancer in Pakistan is 104 per one million and the mortality rate is 65 per one million population. Limited studies have been done to evaluate the diagnostic accuracy of combined mammography and ultrasound with BI-RADS scoring in the detection of breast cancer and positive predictive value of its morphological descriptors in Pakistan. Objective: Our study aims to determine the diagnostic accuracy of combined mammography and ultrasound in the detection of malignant breast lesions using BI-RADS classification taking histopathology as the gold standard and positive predictive value of its morphological descriptors. Materials and Methods: This was a retrospective, cross-sectional analysis. All the patients presented with breast-related symptoms and for screening in whom mammography with complimentary ultrasound was performed were included. Mammography protocol includes image acquisition in craniocaudal and mediolateral oblique views. On ultrasound, all quadrants of the breast, retroaerolar region, and axilla were assessed. Patient stratification was done based on the age, clinical symptoms, and positive malignant lesions on histopathology; and frequency and percentage were calculated. Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and diagnostic accuracy was calculated. PPV of individual morphological descriptors were also calculated. The association of various morphological descriptors with malignancy was analyzed using a chi-square chart. p-value of less than 0.05 was considered significant. Results: In 69 patients with suspicious imaging findings, 89.9% patients presented with breast lumps, 34.8% patients had pain, and 11.6% patients had nipple discharge. 8.7% had nipple retraction and 10.1% had skin changes. 52.2 % patients were post-menopausal and 46.1% patients were premenopausal. On histopathology, 88.4% patients had malignant disease and 11.5% were having benign lesions. The mean age of patients with malignant masses was 50.9 years+13.1 SD. No significant statical difference is noted between younger and older groups. The mean size of the malignant mass was 3.0 cm+1.8 SD. The sensitivity of combined mammogram and ultrasound was calculated to be 98.3%, specificity was 25.0%, PPV was 90.9%, NPV was 66.6% and diagnostic accuracy was 89.9%. Conclusion: We conclude that the combined mammography and ultrasound serve as an important diagnostic tool, both for screening purpose as well as in patients with breast related symptoms for the diagnosis of breast cancer. Moreover, the morphological descriptors of malignancy on mammography and ultrasound as described by BI-RADS lexicon are reliable in","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":"13 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141346362","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":"Cryo-Electron Microscopy in Dental Research","authors":"Dr. Seyedeh Zahra Tarassoli","doi":"10.52916/jmrs244134","DOIUrl":"https://doi.org/10.52916/jmrs244134","url":null,"abstract":"The field of dental research has experienced a significant transformation with the introduction of Cryo-Electron Microscopy (Cryo-EM), a technique that aims for accuracy and originality. This innovative imaging technology has surpassed the limitations of conventional microscopy, allowing for unique understanding of the complex structures and dynamic processes within the dental microcosm. This abstract explores the significant influence of Cryo-EM in dental research, specifically highlighting its crucial role in understanding the intricacies of dental tissues, interactions between biomaterials, and the behavior of microorganisms at the nanoscale. Cryo-EM combines advanced technology and scientific investigation to not only produce detailed images but also record the dynamic movements of molecules in dental biomaterials. This allows for the development of customized dental therapies. This abstract discusses the use of Cryo-EM in studying the structure of enamel, examining the interactions between dental materials and tissues, and analyzing the complex microbial communities in the mouth. Through the clarification of these intricate particulars, Cryo-EM emerges as a revolutionary instrument, molding the field of dental research, diagnostics, and therapeutic treatments. This investigation encompasses the wonders of Cryo-EM, enhancing our comprehension of dental complexities and laying the groundwork for groundbreaking progress in oral healthcare.","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":"55 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140748558","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":"Cutting-Edge Innovations in Minimally Invasive Techniques for Skin Cancer Treatment","authors":"Elahe Najafizadeh, Ahmad Alkhateeb, Regina Mankovskaia","doi":"10.52916/jmrs244133","DOIUrl":"https://doi.org/10.52916/jmrs244133","url":null,"abstract":"Skin cancer is a common and possibly deadly disease that requires immediate and efficient treatment. Conventional surgical methods, although successful, frequently lead to the formation of scars and extended periods of recuperation. In recent years, there have been significant developments in minimally invasive treatments for treating skin cancer. These techniques provide patients with alternative options that result in better cosmetic outcomes and shorter recovery periods. This article is a comprehensive summary of state-of-the-art advancements in minimally invasive procedures, including as laser therapy, cryotherapy, electrochemotherapy, and radiofrequency ablation. We analyze the benefits of these procedures, including minimized scarring, improved cosmetic outcomes, and faster healing periods, while also examining the difficulties and factors involved in their application. We showcase the concrete advantages that patients receive when they undergo minimally invasive therapy for skin cancer, using case studies and success stories as evidence. In addition, we examine potential future paths in research and development, anticipating a favorable outlook for the ongoing use of minimally invasive methods in the treatment of skin cancer. The global prevalence of skin cancer is a substantial health issue, leading to continuous progress in treatment strategies aimed at enhancing patient results. Conventional surgical techniques, however efficient, can lead to conspicuous scarring and extended recuperation periods. Recent advancements in minimally invasive procedures have significantly transformed the treatment of skin cancer, providing patients with alternative options that yield better esthetic results and shorter recovery periods. This article offers a comprehensive analysis of state-of-the-art advancements in minimally invasive procedures, encompassing laser therapy, cryotherapy, electrochemotherapy, and radiofrequency ablation. We use case studies and success stories to demonstrate the concrete advantages that patients gain from these operations, such as minimized scarring and improved cosmetic outcomes. In addition, we explore the difficulties and factors to take into account when putting these methods into practice, along with potential areas for further investigation and advancement. Our goal is to emphasize the hopeful future of minimally invasive treatments in skin cancer care, which will ultimately enhance patient experiences and outcomes.","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":" 31","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140392165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Complication of Percutaneous Endoscopic Gastrostomy Tube Placement: Early Buried Bumper Syndrome (BBS)","authors":"Yasrab Ismail, Sanobar Bughio","doi":"10.52916/jmrs244131","DOIUrl":"https://doi.org/10.52916/jmrs244131","url":null,"abstract":"Early Buried Bumper Syndrome (BBS) is a rare complication of Percutaneous Endoscopic Gastrostomy (PEG) tube placement where the internal bolster gets “buried” in the gastrocutaneous fistulous tract. BBS is usually a late complication. We present a case of early BBS, in Radiology Department of Dr Ziauddin Hospital, Karachi. Patient presented with fever and oozing from the side of PEG tube. CT scan abdomen findings revealed, the bumper of the percutaneous endoscopic gastrostomy tube retracted in subcutaneous fat just adjacent to the gastric wall and seen in the left sided rectus sheath outside the gastric lumen. Contrast was given through the peg during the procedure which show no extravasation of contrast in adjacent soft tissues. These findings consistent with early buried bumper syndrome.","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":" 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140392385","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":"Easiest and Secure Surgical Treatment for Sialocele Post Bichatectomy: An Innovation Surgical Techinque","authors":"Julio Palacios-Juárez, V. Brenda, Sergio G. Moreno-Hernández, Araujo-López Adan, Hurtado-Díaz Luisa Fernanda, Paulina Cardona-Ochoa","doi":"10.52916/jmrs244132","DOIUrl":"https://doi.org/10.52916/jmrs244132","url":null,"abstract":"Introduction: Bichatectomy is one of the most common surgeries of the face, but in any of all the hands, it could be a complication, and the most difficult to treat is the Sialocele, so we made an easy way to treat it, and solve it. Surgical Approach: We present a case of a young female, after the bichatectomy in the 5th day the middle face a Tumor, so we decided to create a new stenon duct, with a drainaige in anatomical position, getting a good result at the moment. Discusion: The bichectomy has an important historical antecedent since in the beginning it was a surgery even without importance in the medical field. The removal of Bichat fat currently has more aesthetic than reconstructive purposes, so the increase of the Sialocele is more tan 3% independent the hands of the surgeon. Conclusion: During the complications of bichatectomy, we decide to create an alternative for the surgeons that are in training, and an easy way to solve it.","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":"75 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140395778","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":"Blood Patch for Post-Surgical Cerebrospinal Fluid Leak: A Case Report","authors":"Martinez Herrera Alvaro, Galvan Talamantes Yazmín, Alvarez Resendiz Gerardo, Chalita Perez-Tagle Christinan, Kleriga Grossgerge Enrique, Zambito Brondo Gerardo","doi":"10.52916/jmrs244129","DOIUrl":"https://doi.org/10.52916/jmrs244129","url":null,"abstract":"Intracranial hypotension syndrome may occur secondary to Cerebrospinal Fluid Leak (CSFL). Its etiology can be iatrogenic, traumatic or spontaneous. The most common cause is related to incidental or intentional punctures during anesthetic approaches. It is a rare complication during lumbar spine surgery. The clinical manifestations of this syndrome are characterized by orthostatic headache as the most frequent symptom, accompanied by a wide variety of manifestations, which frequently result in a disability for daily life activities and a delayed recovery. Diagnosis is made through a detailed medical history, the presence of symptoms and signs, and additional imaging studies. Initial treatment is conservative; however, using a hematic patch is recommended for a significant number of patients as the next step, reserving surgical treatment for cases that are not resolved with these measures. This paper presents the clinical case of a 56-year-old female patient diagnosed with CSF fistula following a surgical procedure, which is treated by applying a blood patch with complete remission of symptoms; similarly, a therapeutic algorithm is proposed for the diagnosis of CSFL.","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":"78 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140440094","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":"Anorectal Melanoma: Not All Dark, Bleeding, and Painful Masses are Hemorrhoids","authors":"Vargas Castillo Elvis, Pérez Mariangela, Melo Amaral Ingrid, Garcilazo Dimas, Prados Manuel","doi":"10.52916/jmrs244127","DOIUrl":"https://doi.org/10.52916/jmrs244127","url":null,"abstract":"Anorectal Melanoma represents less than 1% of all gastrointestinal tumors. They are infrequent, aggressive and with little therapeutic consensus. The prognosis is usually reserved, with a five-year survival rate of less than 20%. The anorectal canal is the most common place where melanomas of the gastrointestinal mucosa appear. Thus, although it represents 0.05 to 4.6% of anorectal lesions, this constitutes the third most common location of melanoma, after the skin and eyes. Generally, their diagnosis is confusing and late, as they require a high index of suspicion; The symptoms are non-specific but they mostly present as dark, bleeding and painful masses, sometimes being confused with benign anorectal processes such as hemorrhoids. This occurred in two clinical cases that we presented in women aged 78 and 59 years with a purplish-black anorectal mass, the first case confused with hemorrhoidal thrombosis and the other with bleeding internal hemorrhoids; therefore, being treated as such in primary medical care centers and delaying their diagnosis by an average of 3 months (Figure A, B and E). Both cases with high clinical suspicion of a malignant process were later confirmed in a specialized unit, where they underwent biopsies and imaging studies. The patients underwent surgery, with subsequent chemo-immunotherapy. The first with abdomino-perineal resection (Figure C) plus inguinal lymphadenectomy (Figure E) and the other with local excision (Figure F). Both neo or adjuvant treatment and type of surgery remain controversial today.","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":"46 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140493260","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":"Antibiotic Impregnated Cement Coated Intramedullary Nailing in the Management of Infected Fractures and Chronic Osteomyelitis of Long Bones","authors":"Manikumar Cj, Pardhasaradhi M","doi":"10.52916/jmrs244126","DOIUrl":"https://doi.org/10.52916/jmrs244126","url":null,"abstract":"Background: In the era of modern transportation there is an increased incidence of compound fractures especially of long bones. As the skin barrier is broken, the bacteria from dirt, other contaminants can colonize at the wound site and thus can cause infection. Healing at the fracture site and that of soft tissues can be severely compromised by infection. So, treating the infection first followed by definitive fixation of fracture will nearly take 4-6 weeks. The antibiotic nailing technique can thus achieve both the targets in a short time. Local delivery of drug controls the infection and the fixation achieves stability. This even reduces the side effects due to over use of systemic and oral antibiotics. Osteomyelitis is also very common which can be hematogenous or post traumatic. This can weaken the bone and can cause fractures with trivial trauma. Discharging sinuses may also be accompanying. So even in this scenario long term use of antibiotics systemically may be required causing side effects. Antibiotic nailing can be very useful in this scenario. Methods: This is a prospective observational study. 20 patients above age of 20 years who were admitted or on follow up during the period of 2 years were considered for study. The patients with infected fractures with or without implant in situ and patients with chronic osteomyelitis with discharging sinuses were included. ASAMI Criteria: The final outcome is graded based on ASAMI criteria proposed by Paley et al. This was usually developed for determining the outcome after treatment of nonunion with Ilizarov ring fixator. It was applied in our study with some modification. Results: The average duration for achieving bony union was around 5 months (20 weeks). Minimum duration for bony union was around 4 months (16 weeks). Maximum duration for bony union was around 7 months (28 weeks) Average duration for control of infection in case of chronic osteomyelitis was around 4 months. Minimum duration for control of symptoms was 5 months. Maximum duration for control of symptoms was 7 months. Conclusion: Antibiotic impregnated cement coated intramedullary nailing is a very good and effective treatment for infected nonunion and chronic osteomyelitis long bones with bone defect less than 2 cm. In case of infected nonunion, as the bone ends will be sclerosed, freshening of ends and bone grafting is needed.","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":" 92","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139621288","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":"https://respubjournals.com/medical-research-surgery/Adnexal-Torsion-in-the-Second-Trimester-of-Pregnancy-A-Case-Report-and-Review-of-the-Literature.php","authors":"Tatjana Barišić, Anđela Azinović","doi":"10.52916/jmrs234123","DOIUrl":"https://doi.org/10.52916/jmrs234123","url":null,"abstract":"Acute abdomen in pregnancy is one of the biggest diagnostic and therapeutic challenges today. Despite advances in medical technology, the preoperative diagnosis of acute abdominal conditions is still inaccurate. Torsion of the adnexa, which refers to complete or partial rotation of the adnexa, resulting in obstruction of venous and lymphatic reflux in the ovary, is a common gynecological emergency. Torn adnexa affect both the ovary and the fallopian tube, and rarely affect only one of them. Adnexal torsion occurs more frequently in the first and early second trimester than in the third trimester. It is difficult to diagnose in advanced pregnancy because of nonspecific symptoms and signs of acute abdomen as well as ultrasound limitations due to uterine enlargement complicate diagnosis. Late diagnosis and delayed surgical treatment result in ovarian loss and fetal endangerment. It is important to thoroughly evaluate the adnexa at the 1st ultrasound examination in pregnancy and to monitor the observed formations.","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":"12 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139003069","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}