Annals of Plastic Surgery最新文献

{"title":"How Big Is Too Big? Validating the Surface-to-Perforator Index in Extended Anterolateral Thigh Flap Reconstruction.","authors":"Georgios Karamitros, Gregory A Lamaris","doi":"10.1097/SAP.0000000000004466","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004466","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Cutaneous Follicle Center Lymphoma: Demographic, Socioeconomic, and Clinical Prognostic Factors in a National Cohort.","authors":"Catherine S Taghizadeh, Gejla Toromani, Beau Hsia, Susan Rafie, Angela Barrera, Christopher L Kalmar","doi":"10.1097/SAP.0000000000004434","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004434","url":null,"abstract":"<p><strong>Purpose: </strong>Primary cutaneous follicle center lymphoma (PCFCL) is a rare form of indolent B-cell lymphoma limited to the skin. This study aims to explore various factors affecting overall survival in patients with PCFCL using data from the National Cancer Database.</p><p><strong>Methods: </strong>Patients with PCFCL were identified in the National Cancer Database between 2004 and 2020 using the International Classification of Diseases for Oncology, Third Edition (ICD-O-3) histology code 9597. Time-to-event outcomes were analyzed with the Kaplan-Meier method, log-rank tests, and multivariable Cox hazard regression models to understand the association of demographic and prognostic factors on survival in patients with PCFCL.</p><p><strong>Results: </strong>During the study interval, 1293 patients were identified with PCFCL, of which 64% were male, 50% were Stage I, and 84% had a Charlson-Deyo (CD) comorbidity score of 0. Key factors associated with worse overall survival included lower income (P = 0.030), nonprivate insurance (P < 0.001), and lower education levels (P = 0.015). Additionally, female sex (P = 0.014), older age (P < 0.001), higher CD scores (P < 0.001), stage II (P = 0.013), stage III (P = 0.003), and lack of primary radiation therapy (P = 0.047) were associated with lower survival. Multivariate analysis confirmed that elevated comorbidity index [hazard ratio (HR) = 5.96, 95% confidence interval (CI): 2.82-12.59, P < 0.001], older age (HR = 1.57, 95% CI: 1.41-1.74, P < 0.001), and higher disease stage (Stage I vs II: HR = 2.15, 95% CI: 1.07-4.29, P = 0.031) were significantly associated with lower survival.</p><p><strong>Conclusions: </strong>In patients with PCFCL, female sex, older age, higher comorbidity index, higher disease stage, lower income, nonprivate insurance, and lower education levels were associated with lower overall survival.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the Safety and Efficacy of Superficial Musculoaponeurotic System and Deep Plane Facelift Techniques: A Systematic Review and Meta-analysis.","authors":"Sushanth Vayalapra, Daniel N Guerero, Vinesh Sandhu, Armand Ak Happy, Delaram Imantalab, Priyanka Kissoonsingh, Ankur Khajuria","doi":"10.1097/SAP.0000000000004454","DOIUrl":"10.1097/SAP.0000000000004454","url":null,"abstract":"<p><strong>Background: </strong>Facelift surgery (rhytidectomy) addresses skin laxity, soft tissue descent, and volume loss, with techniques such as the superficial musculoaponeurotic system (SMAS) and deep plane facelifts offering distinct advantages. However, the optimal technique remains debated due to differences in complication rates and aesthetic outcomes.</p><p><strong>Objective: </strong>The aim of the study was to compare complication rates and aesthetic outcomes of modern facelift techniques.</p><p><strong>Methods: </strong>A systematic search of databases, including MEDLINE, Embase, Cochrane Library, CINAHL, and LILACS, was conducted up to May 2024. Eligible studies reported on SMAS or deep technique facelifts with outcomes such as complication rates, aesthetic results, and patient satisfaction. Studies included randomized controlled trials, cohort studies, and case series with more than 10 patients. A random-effects meta-analysis was used to pool complication rates.</p><p><strong>Results: </strong>A total of 47 studies involving 10,766 patients were included. Hematoma rates were 3% for deep technique facelifts and 2% for SMAS facelifts. Infection rates were low for both techniques. Nerve injury rates were similar between groups; most reported nerve injuries were temporary and resolved over time, while permanent nerve injury was rare. Aesthetic outcomes showed significant improvements with both techniques; however, only one study directly compared them, finding superior midface rejuvenation with deep technique facelifts.</p><p><strong>Conclusions: </strong>Both SMAS and deep techniques demonstrate comparable safety profiles, although limited comparative data and heterogeneous outcome measures preclude definitive conclusions about relative efficacy. While some evidence suggests potential advantages of deep approaches in midface rejuvenation, technique selection should be individualized. Future research requires standardized outcome measures and prospective comparative studies.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parallel Advancements in Art and Anatomy.","authors":"Jaynab R Akhtar, Erin K O'Connor, Kevin C Chung","doi":"10.1097/SAP.0000000000004456","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004456","url":null,"abstract":"<p><strong>Abstract: </strong>The relationship between art and medicine is symbiotic, and one of its foundations is the anatomical dissection. Dissections simultaneously contributed to an advancement of scientific understanding of the human body and the creation of artwork that depicted accurate human anatomy and body movements, specifically in European painting. Dissections became a standard component of both medical education and art training during the Renaissance, which introduced new expectations for artists to acquire a deep understanding of anatomy and reflect this in their work. With each art movement following the Renaissance, artists continued to strengthen their mastery of illustrating the human body and push the boundaries of artistic representation of the body. This paper outlines a brief history of how cadaver dissections became a cornerstone of both medical education and training for artists in European contexts, and the ways in which medical understanding and anatomical accuracy in art developed simultaneously. This is illustrated through close visual analyses of works from 3 time periods and art movements that exhibit increasing anatomical accuracy leading to mastery and artistic freedom.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Course Review-Ultrasound for Plastic Surgeons October 2024.","authors":"Miriam Nyeko-Lacek","doi":"10.1097/SAP.0000000000004339","DOIUrl":"10.1097/SAP.0000000000004339","url":null,"abstract":"<p><strong>Abstract: </strong>Ultrasound scanning is a noninvasive, radiation-free imaging modality, which allows real-time evaluation of anatomical structures and pathology. It has a variety of uses in plastic surgery, including evaluation of structural hand injuries, preoperative perforator mapping, postoperative monitoring, clinical evaluation of breast implants, assessment of soft tissue infections and collections, foreign bodies, and performing regional blocks. The Ultrasound for Plastic Surgeons course held in Manchester familiarizes attendees with the physics of ultrasound and ultrasound technique including probe selection and patient positioning. It includes teaching on using ultrasound for specific purposes such as imaging upper limb and breast pathology, performing regional blocks and flap perforator mapping. Overall, it was a unique and high-quality educational experience, supported by experienced faculty with plenty of opportunity to consolidate skills. This course is recommended to plastic surgery trainees interested in developing the requisite skills to perform ultrasound scanning to support their diagnostic and procedural skills.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"5-6"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Contemporary \"Ertl\": A Functional Below-Knee Amputation for Nontraumatic Comorbid Populations.","authors":"Daisy L Spoer, Rachel N Rohrich, Samuel S Huffman, Lauren E Berger, Arshan Goudarzi, Christian X Lava, Karen Li, Kenneth L Fan, Grant M Kleiber, Christopher E Attinger","doi":"10.1097/SAP.0000000000004394","DOIUrl":"10.1097/SAP.0000000000004394","url":null,"abstract":"<p><strong>Background: </strong>The osteomyoplastic (Ertl) approach to below-knee amputation (BKA) is an alternative to the \"gold standard\" Burgess technique. This study investigates Ertl's functional outcomes and perioperative considerations performed in a highly comorbid patient population.</p><p><strong>Methods: </strong>Medical records of BKA (Ertl and non-Ertl) performed by a single surgeon between January 2017 and October 2021 were retrospectively reviewed.</p><p><strong>Results: </strong>Our cohort comprised 294 BKAs performed via Ertl (n = 51/294, 17.3%) and non-Ertl (n = 243/294, 83%). Ertl patients were younger (50.1 vs 60.6 years, P < 0.001) and had fewer comorbidities (Charlson Comorbidity Index: 2.7 vs 5.5, P < 0.001). Ertl was associated with higher rates of targeted muscle reinnervation than non-Ertl (n = 48/51, 94.1% vs n = 162/239, 67.8%, P < 0.001). There were no significant differences in short-term complications (n = 52/294, 17.7%) or reoperation (n = 57/294, 19.4%) rates. Bony union was demonstrated at a median of 6.1 months without evidence of nonunion beyond 6 months postoperatively. Ertl conferred a shorter time to ambulation (2.3 vs 3.7 months, P < 0.001) and prosthesis use (2.5 vs 3.5 months, P = 0.008). By a median of 15.6 months, a greater percentage of Ertls were ambulatory (n = 46/51, 90.2% vs n = 162/232, 69.4%, P = 0.002). Postoperative pain was minimal without between-group differences. Mortality occurred less often in the Ertl versus non-Ertl group (Ertl n = 1/51, 2.0% vs non-Ertl 50/236, 20.6%, P = 0.001).</p><p><strong>Conclusions: </strong>This study reinforces the current literature on Ertl's functional advantages in appropriate, carefully selected patients and extends our previous work demonstrating the utility in nontraumatic lower extremity amputation for multimorbid patients.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"81-92"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-Assisted Lymphatic Supermicrosurgery for Breast Lymphedema-A Case Report and Literature Review.","authors":"Sonia Kukreja-Pandey, Berk B Ozmen, Graham S Schwarz","doi":"10.1097/SAP.0000000000004364","DOIUrl":"10.1097/SAP.0000000000004364","url":null,"abstract":"<p><strong>Abstract: </strong>Breast lymphedema, an often-overlooked complication of breast cancer treatment, affects nearly half of patients undergoing breast conservation surgery and responds poorly to conservative measures. While lymphaticovenous bypass (LVB) is a well-established intervention for extremity lymphedema, its application in breast lymphedema has been sporadic. We utilized microsurgical robot system in 1 patient to overcome the technical challenges of performing LVB in the breast.A 42-year-old woman developed progressive right breast swelling, heaviness, and pain following lumpectomy, sentinel lymph node biopsy, chemotherapy, and radiotherapy. Conservative measures failed to provide relief. Indocyanine green lymphography (ICGL) revealed normal lymphatic drainage in the arm but dermal backflow in the central and lower breast. Linear patterns in the upper outer quadrant, terminating near the axillary scar, were marked. Using a microsurgical robotic system, 2 end-to-end LVBs were performed through a single skin incision. Immediate postoperative decongestion was observed, with sustained symptomatic improvement at 6 months, evidenced by reduced pain scores and a significant decrease in the Lymphedema Life Impact Score. A literature review identified 6 reports describing 7 cases of LVB for breast lymphedema. The number of bypasses per breast ranged from 1 to 6, with 1 or 2 skin incisions, predominantly in the upper outer quadrant. All cases reported prompt subjective symptom relief, though objective measures were inconsistently applied.Our case demonstrates the first successful application of robotic-assisted LVB for breast lymphedema with significant improvement in clinical signs and symptoms as well as quality of life, based on validated patient-reported outcomes. Robotic assistance enhanced both the feasibility and ergonomics of performing supermicrosurgical LVB in the anatomically complex breast region.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"105-110"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Analysis of Sentinel Lymph Node Sampling Utilizing Sentinel Lymphoscintigraphy Alone Versus the Combined Application of Sentinel Lymphoscintigraphy and Fluorescence Lymphangiography.","authors":"Nurullah Gündüz, Muzaffer Duran, İlknur Akbulut, Serhat Şibar, M Sühan Ayhan","doi":"10.1097/SAP.0000000000004348","DOIUrl":"10.1097/SAP.0000000000004348","url":null,"abstract":"<p><strong>Background: </strong>Sentinel lymph node biopsy (SLNB) plays a crucial role in the clinical staging of cutaneous melanoma, influencing both treatment decisions and survival prognosis. This study aims to evaluate the benefits of combining indocyanine green (ICG) angiography with sentinel lymphoscintigraphy compared to the use of isolated sentinel lymphoscintigraphy.</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted comparing patients who underwent SLNB with isolated sentinel lymphoscintigraphy (isolated group) to those who received SLNB with a combined approach involving both sentinel lymphoscintigraphy and ICG lymphangiography (combined group). The success rates of SLNB, the incidence of false negatives, and the feasibility of using ICG alone were assessed.</p><p><strong>Results: </strong>The success rate for detecting at least 1 lymph node was 92.6% in the isolated group and 100% in the combined group. Among the 16 patients in the isolated group with negative SLNB results, 3 (18.7%) experienced lymph node recurrence. In contrast, none of the 16 patients in the combined group exhibited recurrence ( P > 0.05). The combined method resulted in a 26.7% increase in the average number of excised lymph nodes compared to the isolated method.</p><p><strong>Conclusions: </strong>The integration of ICG lymphangiography with sentinel lymphoscintigraphy enhances lymph node sampling and detection sensitivity, thereby reducing the false-negative rate. However, there is insufficient evidence to support the adequacy of using ICG alone for SLNB.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"70-75"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Optimization of Stromal Vascular Fraction for Remediation of Radiated Fracture Repair: Closing the Gap on Clinical Translation of Cell-Based Therapies.","authors":"Alexandra O Luby, Jessie M Nelson, Gina N Sacks, Melissa Daniel, Lauren Buchman, Jeremy V Lynn, Noah S Nelson, Steven R Buchman","doi":"10.1097/SAP.0000000000004407","DOIUrl":"10.1097/SAP.0000000000004407","url":null,"abstract":"<p><strong>Background: </strong>Mechanical processing techniques to isolate the stromal vascular fraction (SVF) may optimize clinical translation of cell-based therapeutics. Therefore, the purpose of this study was to develop a technique for intraoperative isolation of SVF for immediate therapeutic use with the primary aim of enhancing bone healing at irradiated fracture sites.</p><p><strong>Methods: </strong>Male Lewis rats (n = 29) were divided into groups: fracture, radiation with fracture, and radiation with fracture and SVF implantation. Experimental groups received 35 Gy of targeted radiation. All groups underwent mandibular osteotomy and external fixation. SVF was isolated from inguinal fat pads using Tulip Sizing Transfers, serial filtration, and centrifugation. The resultant cell pellet was implanted at the osteotomy site. After 40 days, bone union and mineralization were evaluated based on gross pathology and micro-computed tomography, respectively, and biomechanical strength testing was performed.</p><p><strong>Results: </strong>SVF treatment increased union rates after radiation (79% vs 20%). Additionally, SVF improved both bone mineral density (666.2 ± 32.0 vs 312.2 ± 51.7; P = 0.000) and bone volume fraction (0.744 ± 0.072 vs 0.350 ± 0.041; P = 0.000) compared with the irradiated control. In fact, SVF treatment into irradiated fracture sites resulted in bone mineral density and bone volume fraction similar to the bone formed at nonirradiated fracture sites, as there was no significant difference between groups. SVF treatment did not significantly improve biomechanical strength compared with the irradiated control.</p><p><strong>Conclusions: </strong>In this study, we developed a novel approach utilizing mechanical methods to enable intraoperative SVF isolation for immediate implantation. SVF demonstrates therapeutic potential for applications in irradiated fracture healing. The results of this study are promising for the long-awaited translation of cell-based therapeutics into the clinical arena.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"100-104"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of 3 Minimally Invasive Surgeries for Treating Axillary Osmidrosis.","authors":"Quan Liu, Wei Li, Zhiqiang Wang, Ruike Cao, Jing Mao, Yiran Zhao","doi":"10.1097/SAP.0000000000004342","DOIUrl":"10.1097/SAP.0000000000004342","url":null,"abstract":"<p><strong>Background: </strong>Axillary osmidrosis is a common cause of physical and social discomfort. Although many treatments are available, there is still room for improvement.</p><p><strong>Objective: </strong>For treatments of axillary osmidrosis 3 minimally invasive surgical methods of nasal endoscope-assisted suction cutting device, liposuction combined with subcutaneous curettage, and small incision trimming method are compared for the clinical efficacy, advantages and disadvantages.</p><p><strong>Methods: </strong>Two hundred fifty-one axillary osmidrosis patients treated respectively with nasal endoscope-assisted suction cutting device, Liposuction with curettage, or small incision trimming method are investigated and the surgical outcomes and complications are analyzed.</p><p><strong>Results: </strong>The effective rate is higher in the endoscopic group compared to the trimming and liposuction with curettage group ( P < 0.025). The postoperative Vancouver Scar Scale and total complication rate in the trimming group are significantly higher than those in the endoscopic and liposuction groups ( P < 0.025). The Hyperhidrosis Disease Severity Scale and overall satisfaction rate was superior in the endoscopic group compared to both liposuction with curettage and trimming groups.</p><p><strong>Conclusions: </strong>Liposuction with curettage has fewer complications and is safer, but with a lower cure rate. The small incision trimming method provides a more thorough treatment but with a higher complication rate. Relatively, nasal endoscope-assisted suction cutting device ensures thorough removal with fewer complications, making it a more recommended method.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"29-32"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}