Brain injury最新文献_第9页

Low-velocity penetrating brain injury: a review of the literature and illustrative case. 低速穿透性脑损伤：文献综述和案例说明。

IF 1.9 4区医学

Brain injury Pub Date : 2024-07-02 Epub Date: 2024-03-31 DOI: 10.1080/02699052.2024.2336067

Richard Cook, Laura Zima, Jawad Khazaal, John Williams

{"title":"Low-velocity penetrating brain injury: a review of the literature and illustrative case.","authors":"Richard Cook, Laura Zima, Jawad Khazaal, John Williams","doi":"10.1080/02699052.2024.2336067","DOIUrl":"10.1080/02699052.2024.2336067","url":null,"abstract":"Introduction: Low-velocity penetrating brain injury (LVPBI) is a class of brain injury where a foreign object violates the skull and damages the brain. Such injuries are rare and consequently understudied.Case: As such, we report an illustrative case of a 29-year-old female with a dense, plastic spike penetrating her right orbit and into her midbrain. After assessment with a CT scan and angiography, the object was removed with careful attention to possible vascular injury. The patient had an uncomplicated post-operative course and received antibiotic and antiepileptic prophylaxis. She was discharged on post-operative day 5, experiencing only mild left-sided weakness.Discussion: Common concerns regarding LVPBI include infection, post-traumatic epilepsy, and vascular injury. A review of published LVPBI cases over the past 20 years demonstrated that most cases (55.2%) are due to accidents. Of patients undergoing surgery, 43.4% underwent a craniotomy, and 22.8% underwent a craniectomy. Despite the grave nature of LVPBI, only 13.5% of the patients died. Additionally, 6.5% of patients developed an infection over their clinical course.Conclusion: In all, more reported cases further paint a picture of the current state of management and outcomes regarding LVPBI, paving the way for more cohesive guidelines to ensure the best possible patient outcomes.","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"668-674"},"PeriodicalIF":1.9,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140329566","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}

引用次数: 0

Cognitive and emotional impairment in stroke survivors: insights from a multi-center study on inpatient rehabilitation therapy. 中风幸存者的认知和情感障碍：住院康复治疗多中心研究的启示。

IF 1.5 4区医学

Brain injury Pub Date : 2024-07-02 Epub Date: 2024-03-25 DOI: 10.1080/02699052.2024.2333398

Lihua Jin, Ying Zhao, Ting Ye, Ying He, Liqing Yao

{"title":"Cognitive and emotional impairment in stroke survivors: insights from a multi-center study on inpatient rehabilitation therapy.","authors":"Lihua Jin, Ying Zhao, Ting Ye, Ying He, Liqing Yao","doi":"10.1080/02699052.2024.2333398","DOIUrl":"10.1080/02699052.2024.2333398","url":null,"abstract":"Background: Individuals recovering from stroke often experience cognitive and emotional impairments, but rehab programs tend to focus on motor skills. The aim of this investigation is to systematically assess the change of magnitude of cognitive and emotional function subsequent to a conventional rehabilitative protocol administered to stroke survivors within a defined locale in China.Methods: This is a multicenter study; a total of 1884 stroke survivors who received in-hospital rehabilitation therapy were assessed on admission (T0) and discharge (T1). The tool of InterRAI was used to assess cognitive, emotional, and behavioral abnormality.Results: The patients aged >60 years, with a history of hypertension, and long stroke onset duration were more exposed to functional impairment (all p < 0.05). Both cognitive and emotional sections were significantly improved at T1 compared to T0 (p < 0.001). Initially, 64.97% and 46.55% of patients had cognitive or emotional impairment at T0, respectively; this percentage was 58.55% and 37.15% at T1.Conclusion: Many stroke survivors have ongoing cognitive and emotional problems that require attention. It is essential to focus on rehabilitating these areas during the hospital stay, especially for older patients, those with a longer recovery, and those with hypertension history.","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"630-636"},"PeriodicalIF":1.5,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140288229","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}

引用次数: 0

Clinical experience with bromocriptine for central hyperthermia after brain insult. 使用溴隐亭治疗脑损伤后中枢性高热的临床经验。

IF 1.9 4区医学

Brain injury Pub Date : 2024-07-02 Epub Date: 2024-03-31 DOI: 10.1080/02699052.2024.2337231

Suneri J Amin, Yasmin Aghajan, Andrew J Webb

{"title":"Clinical experience with bromocriptine for central hyperthermia after brain insult.","authors":"Suneri J Amin, Yasmin Aghajan, Andrew J Webb","doi":"10.1080/02699052.2024.2337231","DOIUrl":"10.1080/02699052.2024.2337231","url":null,"abstract":"Introduction: Bromocriptine is a dopamine receptor agonist used for central hyperthermia with limited data. We describe our single-center experience utilizing bromocriptine for central hyperthermia, including the population treated, most common dosing regimens, adverse events, and discontinuation reasons.Methods: A retrospective study was conducted screening patients who were admitted to intensive care units for acute neurological insults and administered bromocriptine for central hyperthermia between April 2016 and September 2022. Baseline characteristics, disease severity markers, and bromocriptine doses were collected. Body temperatures prior to the first dose of bromocriptine, at the time of dose, and after each dose were recorded. Co-administration of additional hyperthermia management therapies was noted.Results: Thirty patients were included. The most common diagnosis was traumatic brain injury (TBI) (N = 14). The most common reason for discontinuation was resolution of indication (N = 14). Discontinuation due to mild adverse effects occurred in four patients; hepatotoxicity was the most common. There was a paired mean difference of -0.37°C (p = 0.005) between temperatures before and after bromocriptine initiation.Conclusion: Bromocriptine is a potential therapy for the management of central hyperthermia in patients with severe acute neurologic insults who have failed other therapies. Bromocriptine was well tolerated and associated with a low incidence of adverse events.","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"652-658"},"PeriodicalIF":1.9,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140329565","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}

引用次数: 0

Convergence insufficiency in patients with post-concussion syndrome is accompanied by a higher symptom load: a cross-sectional study. 脑震荡后综合征患者的辐辏功能障碍伴有较重的症状负荷：一项横断面研究。

IF 1.9 4区医学

Brain injury Pub Date : 2024-07-02 Epub Date: 2024-03-26 DOI: 10.1080/02699052.2024.2334355

Ivan Nisted, Line Amalie Hellemose, Peter Preben Eggertsen, Lene Odgaard, Toke Bek, Jørgen Feldbæk Nielsen

{"title":"Convergence insufficiency in patients with post-concussion syndrome is accompanied by a higher symptom load: a cross-sectional study.","authors":"Ivan Nisted, Line Amalie Hellemose, Peter Preben Eggertsen, Lene Odgaard, Toke Bek, Jørgen Feldbæk Nielsen","doi":"10.1080/02699052.2024.2334355","DOIUrl":"10.1080/02699052.2024.2334355","url":null,"abstract":"Objective: To estimate the prevalence of convergence insufficiency (CI) in adult patients with post-concussion syndrome and determine the impact of CI on symptom load.Methods: Cross-sectional study of 103 patients with neurological symptoms 2-6 months after a concussion. Symptoms were assessed with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and CI was diagnosed using near point of convergence, vergence facility, and the Convergence Insufficiency Symptom Survey. The RPQ score for patients with and without CI was compared, and sensitivity, specificity, and area under the receiver operating characteristic curve for the two visually related RPQ questions as indicators of CI were calculated.Results: The proportion of patients diagnosed with symptomatic CI was 20.4% (95% confidence interval: 13.1-29.5%). The RPQ score was significantly higher for patients with symptomatic CI both before (p = .01) and after removal of the two visually related questions in the RPQ-questionnaire (p = .03). The two visually related RPQ questions were unable to detect CI.Conclusion: In patients with post-concussion syndrome, the load of nonvisual symptoms is higher in the presence of CI. A prospective interventional study on CI is required to study the relationship between CI and other post-concussion symptoms.","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"645-651"},"PeriodicalIF":1.9,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140288230","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}

引用次数: 0

Efficacy of restitutive interventions for oculomotor deficits in adults with mild traumatic brain injury: a systematic review and meta-analysis. 针对轻度脑外伤成人眼球运动障碍的恢复性干预措施的疗效：系统回顾和荟萃分析。

IF 1.9 4区医学

Brain injury Pub Date : 2024-06-06 Epub Date: 2024-03-03 DOI: 10.1080/02699052.2024.2320163

Melissa Biscardi, Zane Grossinger, Angela Colantonio, Mark Bayley, Tatyana Mollayeva

{"title":"Efficacy of restitutive interventions for oculomotor deficits in adults with mild traumatic brain injury: a systematic review and meta-analysis.","authors":"Melissa Biscardi, Zane Grossinger, Angela Colantonio, Mark Bayley, Tatyana Mollayeva","doi":"10.1080/02699052.2024.2320163","DOIUrl":"10.1080/02699052.2024.2320163","url":null,"abstract":"Background: Mild traumatic brain injury (mTBI) can cause persistent symptoms suggestive of oculomotor deficits. This research synthesized evidence on restitutive interventions for reducing oculomotor deficits in adults with mTBI to understand if these interventions have clinical utility for improving recovery.Methods: Medline, EMBASE, CINHAL, PsychInfo, and Scopus, databases were searched for experimental studies published in English. We rated risk of bias (RoB) using recommended tools, and the certainty of the evidence according to GRADE guidelines. We conducted meta-analyses for similar outcomes reported in at least two studies.Results: Out of 5,328 citations, 12 studies (seven case series and five crossover design), with a combined sample size of 354 participants; (43% males) met the inclusion criteria and were analyzed. The analysis revealed a trend toward improvement of oculomotor deficits and visual tasks in response to restitutive intervention. None of the studies addressed sex or gender effects. All studies had high RoB, suggesting low certainty in the reported results.Discussion: Restitutive interventions may be beneficial for adults with oculomotor deficits after mTBI, however overall certainty of the evidence remains low. Future efforts must include enhancing attention to study methodology and reporting, sex and gender analyses, and reaching a consensus on outcome measures.Prospero registration number: CRD42022352276.","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"499-513"},"PeriodicalIF":1.9,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140020927","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}

引用次数: 0

Improvement of gait and balance function in chronic post-stroke patients induced by Lower Extremity - Constraint Induced Movement Therapy: a randomized controlled clinical trial. 通过下肢约束诱导运动疗法改善慢性中风后患者的步态和平衡功能：随机对照临床试验。

IF 1.9 4区医学

Brain injury Pub Date : 2024-06-06 Epub Date: 2024-03-12 DOI: 10.1080/02699052.2024.2328808

Elaine Menezes-Oliveira, Gabriela da Silva Matuti, Clarissa Barros de Oliveira, Simone Ferreira de Freitas, Catia Miyuki Kawamura, José Augusto Fernandes Lopes, Jean Faber, Ricardo Mario Arida

{"title":"Improvement of gait and balance function in chronic post-stroke patients induced by Lower Extremity - Constraint Induced Movement Therapy: a randomized controlled clinical trial.","authors":"Elaine Menezes-Oliveira, Gabriela da Silva Matuti, Clarissa Barros de Oliveira, Simone Ferreira de Freitas, Catia Miyuki Kawamura, José Augusto Fernandes Lopes, Jean Faber, Ricardo Mario Arida","doi":"10.1080/02699052.2024.2328808","DOIUrl":"10.1080/02699052.2024.2328808","url":null,"abstract":"Objective: To evaluate the effects of Lower Extremity - Constraint Induced Movement Therapy on gait function and balance in chronic hemiparetic patients.Methods: Randomized, controlled, single-blinded study. We recruited chronic post stroke patients and allocated them to Lower Extremity - Constraint Induced Movement Tharapy (LE-CIMT) or Control Group. The LE-CIMT group received this protocol 2.5 hour/day for 15 followed days, including: 1) intensive supervised training, 2) use of shaping as a strategy for motor training, and 3) application of a transfer package. The control group received conventional physiotherapy for 2.5 hours/day for 15 followed days. Outcomes were assessed at baseline, after the interventions, and after 6 months, through 6-minute walk test and Mini-Balance Evaluation Systems Test; 10-meter walk test, Timed Up and Go, 3-D gait analysis, and Lower Extremity - Motor Activity Log.Results: LE-CIMT was superior on the Assistance and confidence subscale of Lower Extremity - Motor Activity Log, Mini-BESTest and 6-minute walk test. The effect size for all outcomes was small when comparing both groups. LE-CIMT showed clinically significant differences in daily activities, balance, and gait capacity, with no clinically significant difference for spatiotemporal parameters.Conclusion: The LE-CIMT protocol had positive outcomes on balance, performance, and confidence perception.","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"559-568"},"PeriodicalIF":1.9,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140101045","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}

引用次数: 0

Crocetin protects mouse brain from apoptosis in traumatic brain injury model through activation of autophagy. 藏红花酸通过激活自噬保护创伤性脑损伤模型中的小鼠大脑免受凋亡。

IF 1.9 4区医学

Brain injury Pub Date : 2024-06-06 Epub Date: 2024-03-03 DOI: 10.1080/02699052.2024.2324022

Shan Chen, Xinghong Luo, Liu Yang, Liang Luo, Zhen Hu, Jianglan Wang

引用次数: 0

Ghrelin ameliorates neuronal damage, oxidative stress, inflammatory parameters, and GFAP expression in traumatic brain injury. 胃泌素可改善创伤性脑损伤的神经元损伤、氧化应激、炎症指标和 GFAP 表达。

IF 1.5 4区医学

Brain injury Pub Date : 2024-06-06 Epub Date: 2024-03-03 DOI: 10.1080/02699052.2024.2324012

Ozlem Ergul Erkec, Eda Acikgoz, Zubeyir Huyut, Mehmet Edip Akyol, Enver Onat Ozyurt, Sıddık Keskin

{"title":"Ghrelin ameliorates neuronal damage, oxidative stress, inflammatory parameters, and GFAP expression in traumatic brain injury.","authors":"Ozlem Ergul Erkec, Eda Acikgoz, Zubeyir Huyut, Mehmet Edip Akyol, Enver Onat Ozyurt, Sıddık Keskin","doi":"10.1080/02699052.2024.2324012","DOIUrl":"10.1080/02699052.2024.2324012","url":null,"abstract":"Objective: This study investigated the effects of ghrelin on oxidative stress, working memory, inflammatory parameters, and neuron degeneration.Methods: TBI was produced with the weight-drop technique. Rats in the G+TBI and TBI+G groups received ghrelin for 7 or 2 days, respectively. The control group received saline. On the 8th day of the study, the brain and blood tissue were taken under anesthesia.Results: A significant increase in brain GSH-PX, MDA, IL-1β, TGF-β1, and IL-8 levels and a significant decrease in CAT levels were found in the TBI group compared to the control. Serum MDA, GSH, IL-1β, and IL-8 levels were increased with TBI. Ghrelin treatment after TBI significantly increased the serum GSH, CAT, GSH-PX, and brain GSH and CAT levels, while it significantly decreased the serum MDA, IL-1β, and brain MDA, TGF-β1, and IL-8 levels. Histological evaluations revealed that ghrelin treatment led to a reduction in inflammation, while also significantly ameliorating TBI-induced neuron damage and vascular injuries. Immunohistochemistry staining showed that GFAP staining intensity was significantly increased in the cortex and hippocampus in TBI, and GFAP immunoreactivity was decreased with ghrelin treatment.Conclusion: The results from this study suggested that ghrelin may have curative effects on TBI.","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"514-523"},"PeriodicalIF":1.5,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140020928","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}

引用次数: 0

Relationship between severity of concussion's symptoms and functional performance in children. 儿童脑震荡症状严重程度与功能表现之间的关系。

IF 1.9 4区医学

Brain injury Pub Date : 2024-06-06 Epub Date: 2024-03-13 DOI: 10.1080/02699052.2024.2329742

Abdulaziz A Alkathiry

{"title":"Relationship between severity of concussion's symptoms and functional performance in children.","authors":"Abdulaziz A Alkathiry","doi":"10.1080/02699052.2024.2329742","DOIUrl":"10.1080/02699052.2024.2329742","url":null,"abstract":"Introduction: Concussion is a common brain injury that has significant effects on multiple functional domains in children. However, limited research exists on the relationship between concussion severity and functional performance in this population. This study aimed to examine the relationship between the severity of concussion symptoms and children's balance and functional performance.Methods: This cross-sectional study recruited 23 children (9 males and 14 females; mean age 13.9 ± 2.2 years) with clinically diagnosed concussions from a tertiary balance center in 2016. Participants underwent clinical and functional evaluations by specialized physical therapists. Symptom severity was assessed using the Post-Concussion Symptom Scale (PCSS), while functional performance was measured using the Functional Gait Assessment (FGA).Results: There was a trend suggesting a negative correlation between symptom severity (PCSS) and functional performance (FGA), indicating potentially better performance in individuals with milder symptoms. However, this trend was not significant (rs (21) = -.072, p = 0.744). Furthermore, no significant correlation was found between FGA scores and the severity of individual symptoms.Conclusion: The findings suggest that concussion symptom severity may not be directly related to functional performance in children. Therefore, it is crucial to incorporate functional performance measures alongside symptom assessment for comprehensive concussion management.","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"569-573"},"PeriodicalIF":1.9,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118758","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}

引用次数: 0

A Look at Traumatic Brain Injury Community Programs in British Columbia: Barriers and facilitators of implementation. 不列颠哥伦比亚省脑外伤社区计划概览》：实施的障碍和促进因素。

IF 1.9 4区医学

Brain injury Pub Date : 2024-06-06 Epub Date: 2024-03-11 DOI: 10.1080/02699052.2024.2327471

Rebecca Tsow, Courtney Pollock, Swati Mehta, Alyssa Turcott, Ruthine Kang, Julia Schmidt

{"title":"A Look at Traumatic Brain Injury Community Programs in British Columbia: Barriers and facilitators of implementation.","authors":"Rebecca Tsow, Courtney Pollock, Swati Mehta, Alyssa Turcott, Ruthine Kang, Julia Schmidt","doi":"10.1080/02699052.2024.2327471","DOIUrl":"10.1080/02699052.2024.2327471","url":null,"abstract":"Research objectives: 1) Characterize the delivery of programs that support acceptance and resiliency for people with brain injury in the healthcare sector; 2) Understand the barriers and facilitators in implementation of programs to support self-acceptance and resiliency for people with brain injury.Design: Participatory focus groups were used to explore experiences of conducting brain injury programs and knowledge of the barriers and facilitators to their implementation. Focus group data were analyzed with manifest content analysis to minimally deviate from broad and structural information provided by participants.Setting: Four focus group sessions were conducted online through a video calling platform.Participants: 22 individuals from community associations conducting programs for people with brain injury. Participants were recruited from a public brain injury organization database.Results: Systemic challenges such as access to and allocation of funding require navigation support. Resource consistency and availability, including stable program leaders and a welcoming atmosphere, are important for program implementation and sustainability. Shared experiences promote connection with the community and personal development.Conclusions: This study informs individual- and community-level approaches to promote meaningful life after brain injury. Findings highlight existing resources and support future programming for people with brain injury.","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"539-549"},"PeriodicalIF":1.9,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140093464","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}

引用次数: 0