Canadian Journal of Surgery最新文献

{"title":"Reasons for 90-day emergency department visits after primary knee arthroplasty.","authors":"Sarah Jennings, Obaid Al-Hubaishi, Jo-Anne Douglas, Evan Nemeth, Michael Dunbar","doi":"10.1503/cjs.008824","DOIUrl":"https://doi.org/10.1503/cjs.008824","url":null,"abstract":"<p><strong>Background: </strong>Postoperative visits to the emergency department (ED) generate additional costs on health care systems and consume already limited resources. We sought to determine the rate and reasons why patients who underwent primary knee arthroplasty returned to the ED within 90 days of postoperative discharge, which could guide the development of preventative measures.</p><p><strong>Methods: </strong>We identified patients who underwent primary knee arthroplasty at 2 hospitals in Nova Scotia, Canada, between April 2021 and March 2022 and who had an ED visit within 90 days of postoperative discharge. We reviewed data for timing and reason for ED visits.</p><p><strong>Results: </strong>Of 687 patients who had primary knee arthroplasty surgeries, 145 (21.1%) patients visited the ED within 90 days of postoperative discharge. Most visits occurred in the early postoperative period, predominantly for surgical reasons (94.7% within 7 days) and shifting toward medical reasons over time. Pain was the most common surgical reason for ED visits (15.9%), followed by swelling (9.7%), and hematoma drainage (9.7%).</p><p><strong>Conclusion: </strong>Understanding the reasons for postoperative ED visits after knee arthroplasty is important in developing strategies to reduce ED overcrowding and improve patient outcomes. Implementing targeted interventions, such as enhanced pain management and patient education, may help alleviate the burden on EDs, reduce costs, and improve overall health care delivery for patients undergoing knee arthroplasty.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589426","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":"Re-excision rates after breast-conserving surgery for invasive breast cancer: an Albertan perspective.","authors":"Joanna F Ryan, Sunita Ghosh, A Nikoo Rajaee, David Olson, David M Lesniak, Lashan J Peiris","doi":"10.1503/cjs.004723","DOIUrl":"https://doi.org/10.1503/cjs.004723","url":null,"abstract":"<p><strong>Background: </strong>Re-operation after breast-conserving surgery for invasive breast cancer is variable among centres and individual surgeons. In this study, we aimed to characterize the current landscape of practice regarding re-operation for invasive breast cancer in the province of Alberta.</p><p><strong>Methods: </strong>This study was a retrospective review of the Synoptec database for patients undergoing primary breast-conserving surgery for invasive breast cancer or reoperation in the province of Alberta in the year 2020. We extracted data on demographic and tumour characteristics, use of intraoperative margin-assessment strategies, and surgical facility. We conducted univariate and multivariate logistic model analyses.</p><p><strong>Results: </strong>We included 1391 breast surgeries in the study. A total of 158 patients underwent re-operation during the study period. The median time to first reoperation was 34 days. The overall re-operation rate was 11.4% (range 5.4%-18.5%) among surgical facilities. The completion mastectomy rate was 5.2%, and 1.5% of patients underwent multiple revisional surgeries. Tumour multifocality was associated with increased revisional surgery rates on multivariate analysis (odds ratio 2.80).</p><p><strong>Conclusion: </strong>The results of this study are consistent with the published literature. We have identified heterogeneity among sites in Alberta for revisional surgery after breast-conserving surgery for invasive breast cancer. This highlights an opportunity for ongoing education and quality improvement in breast cancer care in the province of Alberta.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589457","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":"Perceptions of readiness for independent practice among graduating orthopedic surgery residents in Ontario in the last 30 years.","authors":"Silvio Ndoja, Holly S Howe, Steven R Papp, Emil H Schemitsch, Brent A Lanting","doi":"10.1503/cjs.005124","DOIUrl":"https://doi.org/10.1503/cjs.005124","url":null,"abstract":"<p><strong>Background: </strong>There is increasing concern regarding the lack of physicians and underresourcing of the medical system in Canada. The training of orthopedic surgeons has emerged as an area of particular concern. The purpose of this study was to gain insight into the outcomes of graduates of orthopedic surgery residency programs in Ontario in the last 30 years.</p><p><strong>Methods: </strong>We invited graduates of orthopedic surgery residency programs in Ontario from 1992 to 2020 to participate in our survey regarding their practice patterns and career choices. Participants were asked whether they believed their residency had prepared them for independent practice and were asked about their practice patterns after graduation, including whether they completed fellowships.</p><p><strong>Results: </strong>A total of 618 graduates met the inclusion criteria. We had a response rate of 40.9% (<i>n</i> = 253). A total of 62.8% of participants reported feeling ready to enter independent practice, which was less than the 80% expected threshold. This proportion varied by program and, overall, those who had graduated more recently reported feeling less ready. Nearly all participants had completed at least 1 fellowship, with most trainees having completed 2 fellowships. Earlier graduates were less likely to complete 2 or more fellowships. Completing a fellowship did not help with comfort in practice nor with earlier employment. Most respondents reported that their current surgical skills were primarily influenced by fellowship training, regardless of comfort level in entering practice directly out of residency.</p><p><strong>Conclusion: </strong>A substantial proportion of orthopedic graduates reported not feeling comfortable entering practice directly out of residency, with only 62.8% of participants reporting feeling ready for independent practice after graduation. Furtermore, graduates are incurring a significant opportunity cost completing 1 or often 2 fellowships. These findings necessitate an appraisal of our goals in residency education.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589524","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":"Injury and violence in the context of sustainable development: The first Bethune Round Table in Africa, Bethune Round Table 2024, Conference on Global Surgery, May 16-18, 2024, Addis Ababa, Ethiopia.","authors":"Ronald Lett, Kidist Bartolomeos, Ryan Lett, Tsegazeab Laeke, Abenezer Tirsit, Azarias Kassahun, Respicious Boniface, Victoria Munthali, Tarek Razek, Dan Deckelbaum, David Bracco, Elise Presser, Ermiyas Belay, Fitsum Kifle, Thomas G Weiser, Katie Iverson, Berjo Dongmo Takoutsing, David Ulrich Dalle, Celestin Bilong Mbangtang, Arsene Daniel Nyalundja, Jondre Macaraeg, Irene Dzirasa, Ulrick Sidney Kanmounye, Delanyo Dovlo, Kwadwo Koram, Eugene Nyarko, Desmond T Jumbam, Emnet Tesfay Shimber, Taylor Jaraczewski, Maria Sgro, Ajiel Mae Basmayor, Asegid Ergete, Katherine Iverson, Mary Schroeder, Christopher Dodgion, Adam Gyedu, Emmanuel Nakua, Peter Donkor, Charles Mock, Atalel Awedew, Tsegazeab Laeke, Mestet Yibeltal, Mengistu Ayele, Halid Melkamu, Sisay Bekele, Berhanu Hailemariam, Enku Shiferaw, Yishak Shiferaw, Wubetie Yirdaw, Riya Sawhney, Shlok Patel, Debojit Basak, Deepa Kizhakke Veetil, Nobhojit Roy, Martin Gerdin Wärnberg, Santosh Rath, Mohammed A S Abdullahi, Kefas Mbaya, Abubakar Kakasanda, Stephanie Danjuma, Hector Olasoji, Emmanuel Ameh, Alemayehu Bedada, Mpapho Joseph Motsumi, Shimelis Genna Hamda, Shemsedin Ibro, Demuma Amdisa, Getachew Tilahun, Meseret Abeza, Tsegazeab Laeke, Matthew Boroditsky, Mark Hill, Roy Hilzenrat, Rachel Livergant, Jayd Adams, Catherine Binda, Allison Chhor, Helen Hsiao, Faizal Haji, Esther Chin, Felix Oyania, Caroline Q Stephens, Sarah Ullrich, Meera Kotagal, Francis Bajunirwe, Doruk E Ozgediz, Dan Poenaru, Dionysia Kravarioti, Lye-Yeng Wong, Tsegazeab Laeke Teklemariam, Abenezer Tirsit, Tewodros Liyew, Mark Ferguson, Timothy Plackett, Jaymie Claire Henry, Christopher Dodgion, Meseret Admasu Abeza, Seye Mesfin Minas, Maryse Bouchard, Dimuthu Tennakoon, Riya Sawhney, Rahul Burra, Fleming Mathew, Annabelle Jones, Sargun Virk, Shlok Patel, Tanaz Vaghaiwalla, James Hudspeth, Tracy Rabin, Virginia Rowthorn, Raymond R Price, Nakul Raykar, Gilgamesh Eamer, Stephen Mutiso, Yvette Kisaka, Gladwell Gathecha, Ronald Lett, Chibuike Onu, Emmanuel Ameh, Matthias Igoche, Paschal Anyanwu, Eunice Onuh, Oikeh Ojeamen, Edith Terna Yawe, Amina Abubakar, Yakubu Ashoms, Hadiza Suleiman, Naomi Musa, Daniel Kisitu Kyengera, Netsanet Abebe, Richard Gardener, Dagim Berhanu, Nebyou Seyoum Abebe, Henok T/Silasie Zeleke, Riya Sawhney, Kacylia Roy Proulx, Ayla Gerk, Elena Guadagno, Dan Poenaru, Shreenik Kundu, Boaz Laor, Riya Sawhney, Taylor Wurdeman, Fabio Botelho, Ayla Gerk, Elena Guadagno, Dan Poenaru, Mengistu Ayele, Azarias Kassahun, Tsegazeab Laeke, Mestet Yibeltal, Bereket Hailu, Ermias Fikru, Shemsedin Amme Ibro, Abdeta Workineh, Fikadu Balcha, Fira Abamecha, Sheka Shemsi, Abdullah Saleh Alruwaili, Gabriel Rodriguez, Anna Jose, Shahd Ebied, Samuel Girma, Abigael Abiy, Hussien Endris Assen, Kalab Tesfaye, Kassaye Demeke, Aklilu Yiheyis, Khalid Jemal, Demeke Yilkal, Ashenafi Amsalu, Lema Derseh, Yophtahe W/Gerima, Tadesse Belayneh, Mekuanint Tiruneh, Almaw Bitew, Sewbesew Yitayih, Tadesse Awoke, Chanyalew Worku, Anissa Mohammed, Mohammed Alemu, Mohammed Yesuf, Fantu Mamo, Kegnie Shitu, Biks Liyew, Ayenew Gucho, Gezahegn Tilahun, Timothy Love, Andrew Chew, Brian Kasagga, Berjo Takoutsing, Obuku Ekwaro, Emmanuel Elobu, Degisew Dersso Mengistu, Alex Zhuang, Bethlehem Shiferew, Gelila Mengistu, Ayalew Zewdie, Nahom Tadelle, Alegnta Gebreyesus, Elise Presser, Katie Iverson, Chris Dodgion, Thomas G Weiser, Rachel Koch, Nichole Starr, Davy Lau, Irena Zivkovic, Shahrzad Joharifard, Emilie Joos, Naisan Garraway, Francesca Vituci, Eric O'Flynn, Ines Péric, Léa Simon, Geoffrey Ibbotson, Tsion Seyoum, Aklilu Azazh, Lemlem Beza, Ifeanyichukwu Onah, Chijioke Chukwuma, Dagim Berhanu, Jason Shenoi, Nick Sears, Yoseph Bedore, Richard Caplan, Wongel Tena Shale","doi":"10.1503/cjs.009624","DOIUrl":"10.1503/cjs.009624","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543916","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":"Whole blood and freeze-dried plasma in Canadian trauma care.","authors":"Pierre-Marc Dion, Johnathan Mack, Asim Alam, Sebastian Vuong, Jeff Scott, Damien Miller, Andrew Beckett","doi":"10.1503/cjs.006924","DOIUrl":"10.1503/cjs.006924","url":null,"abstract":"<p><p>SummaryThis article highlights the crucial role of blood transfusion in trauma care and explores the historical and contemporary use of whole blood and freeze-dried plasma in Canadian health care. Early use of whole blood and freeze-dried plasma during global conflicts led to advancements in transfusion medicine. The transition to blood component therapy improved transfusion safety and precision. However, there is an increasing interest in using whole blood and freeze-dried plasma, supported by recent evidence suggesting potential benefits over blood component therapy, particularly in trauma cases. Canadian initiatives, such as leukoreduced whole blood production for the military, indicate efforts to address logistical challenges in delivering trauma care, especially in remote areas. Challenges remain, including logistical issues and regulatory complexities, requiring coordinated efforts for effective implementation. Overall, there's growing support for integrating whole blood and freeze-dried plasma into trauma care across Canada.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495724","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":"Difficult legal precedent established for rural surgical competency.","authors":"Edward J Harvey, Chad G Ball","doi":"10.1503/cjs.011324","DOIUrl":"10.1503/cjs.011324","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495721","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":"Large nonpedunculated colorectal polyp management through the lens of an interventional endoscopist.","authors":"Shirley Jiang, Neal Shahidi","doi":"10.1503/cjs.010623","DOIUrl":"10.1503/cjs.010623","url":null,"abstract":"<p><p>SummaryMinimally invasive endoscopic resection techniques are now the first-line management strategy for most large (> 20 mm) nonpedunculated colorectal polyps (LNPCPs). Appropriate technique selection depends on optical evaluation to predict lesion histopathology alongside the presence of and depth of malignant invasion. We review the indications and performance of endoscopic mucosal resection, cold snare resection, and endoscopic submucosal dissection. These complementary techniques, bolstered by site-specific technical modifications and ancillary techniques, are an effective, efficient, and safe alternative to surgery. An understanding of the role of minimally invasive endoscopic resection techniques is crucial for all endoscopists and surgeons involved in LNPCP management.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495722","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":"Précédent jurisprudentiel difficile pour les chirurgiennes et chirurgiens en milieu rural.","authors":"Edward J Harvey, Chad G Ball","doi":"10.1503/cjs.011824","DOIUrl":"10.1503/cjs.011824","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495723","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":"Role of prolonged packing in postoperative anorectal abscess management: a systematic review and meta-analysis.","authors":"Dain Raina Kim, Kevin Verhoeff, Uzair Jogiat, Alex Miles, Janice Y Kung, Valentin Mocanu","doi":"10.1503/cjs.008423","DOIUrl":"10.1503/cjs.008423","url":null,"abstract":"<p><strong>Background: </strong>Prolonged packing of anorectal abscess cavities with internal dressings after incision and drainage is frequently used, but the efficacy of this practice remains controversial. Some studies highlight its use in hemostasis and preventing fistula and abscess recurrence, whereas others describe its economic burden and increase in pain. In this systematic review, we examine current evidence on the impact of packing after incision and drainage for anorectal abscesses.</p><p><strong>Methods: </strong>The medical librarian conducted a comprehensive literature search on January 5, 2023. We conducted the meta-analysis using RevMan 5.4.1 software with a Mantel-Haenszel random-effects model.</p><p><strong>Results: </strong>We identified 3 randomized controlled trials, comprising 490 patients. Of those, 241 patients (49%) received postoperative packing; most patients were male (<i>n</i> = 158, 65.6%), with a median age of 40.5 years and a follow-up of 6 months. Meta-analysis showed that prolonged wound packing was associated with delayed wound healing and increased pain, but no difference in abscess recurrence or fistula formation.</p><p><strong>Conclusion: </strong>In this systematic review of current evidence highlighting the impact of packing after incision and drainage for anorectal abscesses, we found that the practice is not associated with significant differences in abscess recurrence and fistula formation, but is associated with increased postoperative pain and delayed wound healing.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342241","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":"False-negative sentinel lymph node biopsy for melanoma: a single-surgeon experience.","authors":"Julia Downey, Kimberly DeVries, Ian Marie Lano, Christopher Baliski","doi":"10.1503/cjs.016023","DOIUrl":"10.1503/cjs.016023","url":null,"abstract":"<p><strong>Background: </strong>The status of the regional lymph node basin is of prognostic importance in patients with melanoma, making the performance of sentinel lymph node biopsies (SLNBs) a key component of patient care management, particularly with the advent of immunotherapy for adjuvant treatment. The primary goal of our study was to assess the false-negative rate of SLNBs among patients with melanoma.</p><p><strong>Methods: </strong>We conducted a retrospective review of patients with melanoma undergoing SLNB by a single surgeon between Jan. 1, 2005, and Dec. 31, 2020. We extracted and cross-referenced patient demographic and pathologic information.</p><p><strong>Results: </strong>During the study period, 501 patients underwent an SLNB. Of these, 97 (19.4%) patients had pathologically positive sentinel lymph nodes and 404 (80.6%) patients had negative results. The latter were subject to further review; 84 (20.8%) patients subsequently developed recurrence, with 25 (6.2%) recurrences within the primary nodal basin. Isolated regional recurrence occurred in 11 (2.7%) patients and conjunction with a false-negative rate was 10.2%. Unadjusted recurrence rates were similar across each lymph node basin, including the axilla (2.7%), groin (3.6%), and neck (1.4%).</p><p><strong>Conclusion: </strong>The false-negative SLNB rate was 10.2% for isolated regional recurrences. These findings need to be considered in the era of using adjuvant systemic therapy for patients with melanoma.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342240","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}