Samuel Khodursky PhD , Shuai Yuan PhD , Joshua M. Spin MD, PhD , Philip S. Tsao PhD , Michael G. Levin MD , Scott M. Damrauer MD
{"title":"Plasma proteome-wide Mendelian randomization reveals the association of extracellular matrix proteins with abdominal aortic aneurysm","authors":"Samuel Khodursky PhD , Shuai Yuan PhD , Joshua M. Spin MD, PhD , Philip S. Tsao PhD , Michael G. Levin MD , Scott M. Damrauer MD","doi":"10.1016/j.jvssci.2025.100290","DOIUrl":"10.1016/j.jvssci.2025.100290","url":null,"abstract":"<div><h3>Objective</h3><div>Abdominal aortic aneurysm (AAA) is a common and life-threatening vascular disease. Genetic studies have identified numerous risk loci, many potentially encoding plasma proteins. However, the causal effects of plasma proteins on AAAs have not been thoroughly studied. We used genetic causal inference approaches to identify plasma proteins that have a potential causal impact on AAAs.</div></div><div><h3>Methods</h3><div>Causal inference was performed using two-sample Mendelian randomization (MR). For AAAs, we utilized recently published summary statistics from a multi-population genome-wide association meta-analysis including 39,221 individuals with and 1,086,107 individuals without AAAs from 14 cohorts. We used protein quantitative trait loci (protein quantitative trait loci) identified in two large-scale plasma-proteomics studies (deCODE and UKB-PPP) to generate genetic instruments. We tested 2783 plasma proteins for possible causal effects on AAAs using two-sample MR with inverse variance weighting with common sensitivity analyses.</div></div><div><h3>Results</h3><div>MR identified 90 plasma proteins associated with AAAs at a false discovery rate <0.05, with 25 supported by colocalization analysis. Among those supported by both MR and colocalization were proteins such as PCSK9 (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.2-1.4; <em>P</em> < 1e-10), LTBP4 (OR, 3.4; 95% CI, 2.6-4.6; <em>P</em> < 1e-10), and COL6A3 (OR, 0.6; 95% CI, 0.5-0.7; <em>P</em> < 1e-6). Gene Ontology analysis revealed enrichment of proteins (extracellular matrix; OR, 7.8; <em>P</em> < 1e-4), some with maximal mRNA levels in aortic tissue. Bi-directional MR suggested plasma level changes were not caused by liability to AAA itself. Colocalization analysis showed that an aortic expression quantitative trait locus for COL6A3, and a splicing quantitative trait locus for LTBP4 colocalized with their respective plasma pQTLs and AAA signals.</div></div><div><h3>Conclusions</h3><div>Our results highlight proteins and pathways with potential causal effects on AAAs, providing a foundation for future functional experiments. These findings suggest a possible causal pathway whereby genetic variation affecting extracellular matrix proteins expressed in the aortic wall cause their levels to change in blood plasma, influencing development of AAAs.</div></div>","PeriodicalId":74035,"journal":{"name":"JVS-vascular science","volume":"6 ","pages":"Article 100290"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144306431","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":"Toll-Like Receptor 4, a potential therapeutic target of lower limb ischemic myopathy that raises further questions","authors":"Ali H. Hakim, Ulf Hedin","doi":"10.1016/j.jvssci.2024.100195","DOIUrl":"https://doi.org/10.1016/j.jvssci.2024.100195","url":null,"abstract":"","PeriodicalId":74035,"journal":{"name":"JVS-vascular science","volume":"60 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139824700","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}
Anand H. Brahmandam, Rafael Alves, Hao Liu, Luis Gonzalez, Y. Aoyagi, Yuichi Ohashi, John T. Langford, Carly Thaxton, R. Taniguchi, Weichang Zhang, Hualong Bai, B. Yatsula, Alan Dardik
{"title":"A central arteriovenous fistula reduces systemic hypertension in a mouse model","authors":"Anand H. Brahmandam, Rafael Alves, Hao Liu, Luis Gonzalez, Y. Aoyagi, Yuichi Ohashi, John T. Langford, Carly Thaxton, R. Taniguchi, Weichang Zhang, Hualong Bai, B. Yatsula, Alan Dardik","doi":"10.1016/j.jvssci.2024.100191","DOIUrl":"https://doi.org/10.1016/j.jvssci.2024.100191","url":null,"abstract":"","PeriodicalId":74035,"journal":{"name":"JVS-vascular science","volume":"22 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139892707","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}
Xiao Luo, Fattah Muhammad Tahabi, Dave M. Rollins, A. Sawchuk
{"title":"Predicting Future Occlusion or Stenosis of Lower Extremity Bypass Grafts Using Artificial Intelligence to Simultaneously Analyze All Flow Velocities Collected in Current and Previous Ultrasound Exams","authors":"Xiao Luo, Fattah Muhammad Tahabi, Dave M. Rollins, A. Sawchuk","doi":"10.1016/j.jvssci.2024.100192","DOIUrl":"https://doi.org/10.1016/j.jvssci.2024.100192","url":null,"abstract":"","PeriodicalId":74035,"journal":{"name":"JVS-vascular science","volume":"72 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139874367","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}
Dahlia M. Kenawy MD , Jordan F. Stafford MD , Foued Amari MS , Drayson Campbell BS , Mahmoud Abdel-Rasoul MS, MPH , Jennifer Leight PhD , Youngjae Chun PhD , Bryan W. Tillman MD, PhD
{"title":"A porcine model of thoracic aortic aneurysms created with a retrievable drug infusion stent graft mirrors human aneurysm pathophysiology","authors":"Dahlia M. Kenawy MD , Jordan F. Stafford MD , Foued Amari MS , Drayson Campbell BS , Mahmoud Abdel-Rasoul MS, MPH , Jennifer Leight PhD , Youngjae Chun PhD , Bryan W. Tillman MD, PhD","doi":"10.1016/j.jvssci.2024.100212","DOIUrl":"10.1016/j.jvssci.2024.100212","url":null,"abstract":"<div><h3>Objective</h3><p>Aneurysm pathophysiology remains poorly understood, in part from the disparity of murine models with human physiology and the requirement for invasive aortic exposure to apply agents used to create aneurysm models. A retrievable drug infusion stent graft (RDIS) was developed to isolate the aortic wall intraluminally for drug exposure. We hypothesized that an RDIS could deliver aneurysm-promoting enzymes to create a porcine model of thoracic aneurysms without major surgical exposure.</p></div><div><h3>Methods</h3><p>Retrievable nitinol stent graft frames were designed with an isolated drug delivery chamber, covered with polytetrafluoroethylene, and connected to a delivery wire with a drug infusion catheter installed to the outer chamber. Institutional Animal Care and Use Committee-approved Yorkshire pigs (n = 5) underwent percutaneous access of the femoral artery, baseline aortogram and stent placement in the thoracic aorta followed by 30-minute exposure to a cocktail of elastase, collagenase, and trypsin. After aspiration of excess drug, stent retrieval, and femoral artery repair, animals were recovered, with angiograms at 1 and 4 weeks followed by explant. Histological analysis, in situ zymography, and multiplex cytokine assays were performed.</p></div><div><h3>Results</h3><p>The RDIS isolated a segment of anterior aorta angiographically, while the center lumen preserved distal perfusion during drug treatment (baseline femoral mean arterial pressure, 70 ± 14 mm Hg; after RDIS, 75 ± 12; <em>P</em> = .55). Endovascular induction of thoracic aneurysms did not require prior mechanical injury and animals revealed no evidence of toxicity. Within 1 week, significant aneurysmal growth was observed in all five animals (1.4 ± 0.1 cm baseline to 2.9 ± 0.7 cm; <em>P</em> = .002) and only within the treated region of the aorta. Aneurysms persisted out to 4 weeks. Aneurysm histology demonstrated loss of elastin and collagen that was otherwise preserved in untreated aorta. Proinflammatory cytokines and increased matrix metalloproteinase activity were increased significantly within the aneurysm.</p></div><div><h3>Conclusions</h3><p>An RDIS achieves isolated drug delivery while preserving distal perfusion to achieve an endovascular porcine model of thoracic aneurysms without major surgery. This model may have value for surgical training, device testing, and to better understand aneurysm pathogenesis. Most important, although the RDIS was used to simulate aortic pathology, this tool offers intriguing horizons for focused therapeutic drug delivery directly to aneurysms and, more broadly, focused locoregional drug delivery to vessels and vascular beds.</p></div>","PeriodicalId":74035,"journal":{"name":"JVS-vascular science","volume":"5 ","pages":"Article 100212"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666350324000233/pdfft?md5=081f8c71c9fcfe81f38b0cc25693ed2d&pid=1-s2.0-S2666350324000233-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141715761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anand Brahmandam MD , Joshua Huttler BA , Kirthi Bellamkonda MSc , Ocean Setia MD , Jonathan A. Cardella MD , William Stewart PhD , Raul J. Guzman MD , Cassius Iyad Ochoa Chaar MD, MS, MPH
{"title":"The radiographic relationship of the femoral head, inguinal ligament, and common femoral artery bifurcation for optimal vascular access","authors":"Anand Brahmandam MD , Joshua Huttler BA , Kirthi Bellamkonda MSc , Ocean Setia MD , Jonathan A. Cardella MD , William Stewart PhD , Raul J. Guzman MD , Cassius Iyad Ochoa Chaar MD, MS, MPH","doi":"10.1016/j.jvssci.2024.100196","DOIUrl":"10.1016/j.jvssci.2024.100196","url":null,"abstract":"<div><h3>Objective</h3><p>Common femoral artery (CFA) access is commonly used for endovascular interventions. Access site complications contribute to significant morbidity and mortality. This study characterizes the radiographic variability in the relationship of the femoral head, the inguinal ligament, and the CFA bifurcation, to identify the zone of optimal CFA access.</p></div><div><h3>Methods</h3><p>Human cadaver dissection of the inguinal ligament and CFA bifurcation was performed. The inguinal ligament and CFA bifurcation were marked with radiopaque pins and plain anteroposterior radiographs were obtained. Radiographic measurements of the femoral head length, the distance of the top of the femoral head to the inguinal ligament, and to the CFA bifurcation were obtained. Results were reported as percentage of femoral head covered by the inguinal ligament or the CFA bifurcation relative to the top of the femoral head. A heatmap was derived to determine a safe access zone between the inguinal ligament and CFA bifurcation.</p></div><div><h3>Results</h3><p>Forty-five groin dissections (male, n = 20; female, n = 25) were performed in 26 cadavers. The mean overlap of the inguinal ligament with the femoral head was 11.2 mm (range, −19.4 to 27.4 mm). There were no age (<85 vs ≥85 years) or sex-related differences. In 82.6% of cadaveric CFA exposures, there was overlap between the inguinal ligament and femoral head (mean, 27.7%; range, −85.7% to 70.1%), with 55.6% having a >25% overlap. In 11.1%, there was an overlap between the lower one-third of the femoral head and the CFA bifurcation. Cumulatively, heatmap analysis depicted a >80% likelihood of avoiding the inguinal ligament and CFA bifurcation below the midpoint of the femoral head.</p></div><div><h3>Conclusions</h3><p>Significant variability exists in the relationship between the inguinal ligament, CFA bifurcation, and the femoral head, suggesting the lack of a consistently safe access zone. The safest access zone in >80% of patients lies below the radiographic midpoint of the femoral head and the inferior aspect of the femoral head.</p></div>","PeriodicalId":74035,"journal":{"name":"JVS-vascular science","volume":"5 ","pages":"Article 100196"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666350324000075/pdfft?md5=74563e889c098870416176f9c73dad33&pid=1-s2.0-S2666350324000075-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140462865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mengjun Wang MD , Xiao Lu PhD , Ling Han BS , José A. Diaz MD , Seshadri Raju MD , Ghassan S. Kassab PhD
{"title":"Venous thromboembolism swine model with reflux-induced venous hypertension","authors":"Mengjun Wang MD , Xiao Lu PhD , Ling Han BS , José A. Diaz MD , Seshadri Raju MD , Ghassan S. Kassab PhD","doi":"10.1016/j.jvssci.2024.100200","DOIUrl":"10.1016/j.jvssci.2024.100200","url":null,"abstract":"<div><h3>Objective</h3><p>This study describes a novel swine model of venous thromboembolism (VTE) with reflux-induced venous hypertension.</p></div><div><h3>Methods</h3><p>Six pigs underwent disruption of the tricuspid chordae tendineae to create reflux and venous hypertension in the femoral vein. The vein was traumatized 2 to 3 weeks later by repeated withdrawal of a slightly overinflated occlusion balloon across the lumen, followed by balloon occlusion of the outflow. A small amount of thrombin was injected into the traumatized vein segment immediately after outflow occlusion. Thrombosis of the traumatized vein evolved into an organized thrombus seven weeks later. The histological features of the harvested post-thrombotic femoral vein were studied with hematoxylin and eosin and Trichrome stains.</p></div><div><h3>Results</h3><p>In all six pigs, initial disruption of the chordae tendineae was successfully performed to create tricuspid reflux and venous hypertension. After two-stage sequential procedures, a thrombus formed in the target femoral vein segment. Histology of the harvested thrombotic vein showed features of an organizing thrombus with collagen formation and fibrosis.</p></div><div><h3>Conclusions</h3><p>The novel swine VTE model may serve as a platform for developing and testing human-sized therapeutic procedures and devices in translational venous research.</p></div><div><h3>Clinical Relevance</h3><p>This study describes a swine model of VTE created by incorporating all three elements of Virchow’s triad. The model uniquely incorporates reflux-induced venous hypertension, which may be used in studying venous insufficiency and VTE in those with systemic venous hypertension. Likewise, this model may serve as a platform for development and evaluation of diagnostic imaging or therapeutic procedures and devices in subjects with systemic venous hypertension.</p></div>","PeriodicalId":74035,"journal":{"name":"JVS-vascular science","volume":"5 ","pages":"Article 100200"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666350324000117/pdfft?md5=e4da82e55e93a6015beb2e6e9d227379&pid=1-s2.0-S2666350324000117-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sean M. Carr PhD , Katherine Owsiany MD, PhD , Ottis Scrivner PhD , Dylan McLaughlin MD , Hanjoong Jo PhD , Luke P. Brewster , Katherine E. Hekman MD, PhD
{"title":"Hyperoxia impairs induced pluripotent stem cell-derived endothelial cells and drives an atherosclerosis-like transcriptional phenotype","authors":"Sean M. Carr PhD , Katherine Owsiany MD, PhD , Ottis Scrivner PhD , Dylan McLaughlin MD , Hanjoong Jo PhD , Luke P. Brewster , Katherine E. Hekman MD, PhD","doi":"10.1016/j.jvssci.2024.100193","DOIUrl":"10.1016/j.jvssci.2024.100193","url":null,"abstract":"<div><h3>Background</h3><p>Induced pluripotent stem cells (iPSCs) directed to endothelial identity (iPSC-ECs) are emerging as a potent tool for regenerative medicine in vascular disease. However, iPSC-ECs lose expression of key identity markers under standard in vitro conditions, limiting their clinical applications.</p></div><div><h3>Methods</h3><p>To model physiological in vivo conditions, we examined the bioenergetics, presence of key cell markers, and proliferative and angiogenic capacity in iPSC-ECs at late and early passage under hyperoxic (21%) and physiological (4%) oxygen concentrations.</p></div><div><h3>Results</h3><p>Physoxia resulted in relative preservation of mitochondrial bioenergetic activity, as well as CD144 expression in late passage iPSC-ECs, but not proliferative capacity or tube formation. Single cell RNA sequencing (scRNA-seq) revealed that late passage hyperoxic iPSC-ECs develop an endothelial-to-mesenchymal phenotype. Comparing scRNA-seq data from iPSC-ECs and from atherosclerotic ECs revealed overlap of their transcriptional phenotypes.</p></div><div><h3>Conclusions</h3><p>Taken together, our studies demonstrate that physiological 4% oxygen culture conditions were sufficient to improve mitochondrial function in high passage cells, but alone was insufficient to preserve angiogenic capacity. Furthermore, late passage cells under typical conditions take on an endothelial-to-mesenchymal phenotype with similarities to ECs found in atherosclerosis.</p></div>","PeriodicalId":74035,"journal":{"name":"JVS-vascular science","volume":"5 ","pages":"Article 100193"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266635032400004X/pdfft?md5=8e5c3056fafd9f25b14200fbd26c3111&pid=1-s2.0-S266635032400004X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140279855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jinglian Yan PhD, Guodong Tie PhD, Amanda Tutto MS, Louis M. Messina MD
{"title":"Hypercholesterolemia impairs collateral artery enlargement by ten-eleven translocation 1-dependent hematopoietic stem cell autonomous mechanism in a murine model of limb ischemia","authors":"Jinglian Yan PhD, Guodong Tie PhD, Amanda Tutto MS, Louis M. Messina MD","doi":"10.1016/j.jvssci.2024.100203","DOIUrl":"10.1016/j.jvssci.2024.100203","url":null,"abstract":"<div><h3>Objective</h3><p>The extent of collateral artery enlargement determines the risk of limb loss due to peripheral arterial disease. Hypercholesterolemia impairs collateral artery enlargement, but the underlying mechanism remains poorly characterized. This study tests the hypothesis that hypercholesterolemia impairs collateral artery enlargement through a ten-eleven translocation 1 (Tet1)-dependent hematopoietic stem cell (HSC)-autonomous mechanism that increases their differentiation into proinflammatory Ly6C<sup>hi</sup> monocytes and restricts their conversion into proangiogenic Ly6C<sup>low</sup> monocytes.</p></div><div><h3>Methods</h3><p>To test our hypothesis, we induced limb ischemia and generated chimeric mouse models by transplanting HSCs from either wild-type (WT) mice or hypercholesterolemic mice into lethally irradiated WT recipient mice.</p></div><div><h3>Results</h3><p>We found that the lethally irradiated WT recipient mice reconstituted with HSCs from hypercholesterolemic mice displayed lower blood flow recovery and collateral artery enlargement that was nearly identical to that observed in hypercholesterolemic mice, despite the absence of hypercholesterolemia and consistent with an HSC-autonomous mechanism. We showed that hypercholesterolemia impairs collateral artery enlargement by a Tet1-dependent mechanism that increases HSC differentiation toward proinflammatory Ly6C<sup>hi</sup> monocytes and restricts the conversion of Ly6C<sup>hi</sup> monocytes into proangiogenic Ly6C<sup>low</sup> monocytes. Moreover, Tet1 epigenetically reprograms monocyte gene expression within the HSCs. Restoration of Tet1 expression in HSCs of hypercholesterolemic mice restores WT collateral artery enlargement and blood flow recovery after induction of hindlimb ischemia.</p></div><div><h3>Conclusions</h3><p>These results show that hypercholesterolemia impairs collateral artery enlargement by a novel Tet1-dependent HSC-autonomous mechanism that epigenetically reprograms monocyte gene expression within the HSCs.</p></div>","PeriodicalId":74035,"journal":{"name":"JVS-vascular science","volume":"5 ","pages":"Article 100203"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666350324000142/pdfft?md5=49f36588f10b5565ecc9178f0c001b46&pid=1-s2.0-S2666350324000142-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140797169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}