CardioVascular and Interventional Radiology最新文献

{"title":"Safety and Efficacy of Portal Vein Recanalization with Creation of Intrahepatic Portosystemic Shunt (PVR-TIPS) to Treat Chronic Portal Vein Thrombosis in Non-cirrhotic Patients.","authors":"F Barbosa, P Aseni, M Vertemati, C Becchetti, A Airoldi, A De Gasperi, P Gemma, F Morelli, A Alfonsi, P Brambillasca, M Solcia, C Andriullo, F Ferla, M Nichelatti, G Perricone, S De Nicola, L Belli, A Rampoldi, F C Carnevale","doi":"10.1007/s00270-024-03923-6","DOIUrl":"10.1007/s00270-024-03923-6","url":null,"abstract":"<p><strong>Purpose: </strong>This study assesses the efficacy and safety of Portal Vein Recanalization with Intrahepatic Portosystemic Shunt (PVR-TIPS) in non-cirrhotic patients with chronic portal vein occlusion (CPVO), cavernomatous transformation, and symptomatic portal hypertension (PH) and/or portal vein thrombotic progression.</p><p><strong>Material and methods: </strong>Medical records of 21 non-cirrhotic patients with CPVO and portal cavernoma undergoing PVR-TIPS were analyzed. Hemodynamic (intraprocedural reduction in portosystemic pressure gradient), clinical (data on gastrointestinal bleeding, abdominal pain, ascites, and presence of esophageal varices from imaging exams) and technical success (PVR-TIPS) assessed efficacy. Safety was determined through complications classified according to the CIRSE Classification System.</p><p><strong>Results: </strong>PVR-TIPS was successfully performed in all patients, resulting in a significant reduction in portal pressure gradient by 10 mmHg (21.475 ± 9.7 mmHg - 11.454 ± 5,4 mmHg, p < 0.001), alleviating portal hypertension symptoms without thrombotic progression. Clinical success included resolution or reduction of ascites (p = 0.016), gastroesophageal varices (p = 0.004), abdominal pain (p = 0.0021), and cessation of gastrointestinal bleeding (p = 0.021). Complications occurred in 33% of patients, including six grade III events (1 perioperative liver bleeding, 5 delayed stent occlusions) and one grade VI event resulting in death (4.8%). Primary patency rate was 76% (21.3 months, range:0.2-82), secondary patency 100% (4 months, range:3.8-40.8). Survival at follow-up was 90.4%, with one unrelated death. One patient underwent liver transplantation, three became eligible post-recanalization.</p><p><strong>Conclusion: </strong>PVR-TIPS proves effective and safe in reducing portal pressure gradient, thereby alleviating PH symptoms without evidence of portal thrombosis progression in non-cirrhotic patients with CPVO and portal cavernoma. It expands therapeutic options, including liver transplantation.</p>","PeriodicalId":9591,"journal":{"name":"CardioVascular and Interventional Radiology","volume":" ","pages":"351-361"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Left Moderate or Severe Common Iliac Vein Compression and Occurrence of Involved Iliac Vein Thrombosis in Patients with Infrainguinal Deep Vein Thrombosis.","authors":"Maofeng Gong, Rui Jiang, Xu He, Zhengcan Wu, Jianping Gu","doi":"10.1007/s00270-025-03971-6","DOIUrl":"10.1007/s00270-025-03971-6","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the association between the degree of common iliac vein (CIV) compression and the incidence of iliac vein involvement thrombosis (IVT) in patients with infrainguinal deep vein thrombosis (DVT).</p><p><strong>Methods: </strong>This was a single center retrospective study. Between January 2015 and July 2023, infrainguinal DVT patients with or without IVT were included. Patient baseline demographics, clinical characteristics, and radiographic variables were collected and analyzed. Univariate analysis followed by multivariate analysis was used for IVT to determine odds ratio (OR) with a 95% confidence interval (CI). The association of the degree of CIV compression and IVT was evaluated by restricted cubic spines (RCS) on a continuous scale.</p><p><strong>Results: </strong>222 left-sided DVT patients [140 (63.1%) patients diagnosed with IVT, and 82 (36.9%) without] were included. Univariate analyses revealed a higher prevalence of female gender (55.7 vs. 41.5%, p = .040) and CIV compression among patients with left-sided IVT compared to those without IVT. After adjusting for female gender, a strong positive association between IVT and moderate (compression degree > 50% and ≤ 75%) (adjusted OR 3.75; 95% CI 1.571-8.974; p = .003) to severe (> 75%) (adjusted OR 4.05; 95% CI 1.615-10.134; p = .003) CIV compression degrees remained, indicating moderate or severe compression significantly increased IVT risk. RCS showed that a greater CIV minimum diameter or a smaller compression percentage was negatively associated with IVT incidence at a CIV minimum diameter was > 4.1 mm (p < .001) or compression percentage was < 61.0% (p < .001).</p><p><strong>Conclusion: </strong>Moderate and severe CIV compression were associated with increased IVT risk compared to no or mild compression. A decreasing degree of CIV compression was consistently associated with a decreasing risk of IVT when the minimum diameter was > 4.1 mm or the compression was < 61.0%.</p>","PeriodicalId":9591,"journal":{"name":"CardioVascular and Interventional Radiology","volume":" ","pages":"304-313"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation Lobectomy in Adjunct to Double Vein Embolization to Reach Sufficient Future Liver Remnant in Patients with Colorectal Cancer Liver Metastases: A Case Series.","authors":"D Andel, K Ramdhani, A J A T Braat, R C G Bruijnen, G Bol, G Keane, M G E H Lam, O W Kranenburg, I H M Borel Rinkes, J Hagendoorn, M L J Smits","doi":"10.1007/s00270-024-03892-w","DOIUrl":"10.1007/s00270-024-03892-w","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the outcome of radiation lobectomy (RL) after double vein embolization (portal vein embolization + hepatic vein embolization) for patients with insufficient future liver remnant growth.</p><p><strong>Materials and methods: </strong>All patients with insufficient FLR function (as determined by hepatobiliary scintigraphy (HIDA); < 2.7%/min/m²) after double vein embolization who underwent RL between 2020 and 2023 were selected. Follow-up consisted of toxicity graded according to the Common Terminology Criteria for Adverse Events v. 5.0 criteria, HIDA and computed tomography imaging at 1-2-month intervals to assess treatment effect and resectability. Postoperative complications were graded according to the Clavien-Dindo system.</p><p><strong>Results: </strong>Five patients with colorectal liver metastases were selected. After RL, 4/5 patients had sufficient FLR function. Overall, the median volumetric and functional increase of the FLR was 47.5% (range 5.8-102.8%) and 66.7% (range 0-233.3%), respectively, and within a median of 81 days. No severe toxicities were reported after adjunct RL. Two patients did not undergo surgery due to disease progression. Three patients underwent surgery. The postoperative stay was complicated by persistent bile leakage in one patient and respiratory insufficiency in another. There was no 90-day mortality.</p><p><strong>Conclusion: </strong>RL was safely employed in adjunct to double vein embolization to induce a further increase in the FLR volume and function.</p>","PeriodicalId":9591,"journal":{"name":"CardioVascular and Interventional Radiology","volume":" ","pages":"379-385"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Less is More? Balancing Innovation with Safety is Essential to the Advancement of the Emborrhoid Technique.","authors":"Qian Yu, Vincent Vidal","doi":"10.1007/s00270-025-03988-x","DOIUrl":"10.1007/s00270-025-03988-x","url":null,"abstract":"","PeriodicalId":9591,"journal":{"name":"CardioVascular and Interventional Radiology","volume":" ","pages":"395-397"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrievable Scaffold Therapy Combined with Sirolimus-coated Balloon Angioplasty for Infrapopliteal Artery Disease: Final Results from the DEEPER LIMUS Trial.","authors":"Leyla Schweiger, Katharina Gütl, Peter Rief, Clemens Reiter, Michael Janisch, Ido Weinberg, Raghu Kolluri, Larry E Miller, Marianne Brodmann","doi":"10.1007/s00270-025-03987-y","DOIUrl":"10.1007/s00270-025-03987-y","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the safety and efficacy of retrievable scaffold therapy combined with sirolimus-coated balloon angioplasty for treating infrapopliteal artery lesions.</p><p><strong>Methods: </strong>The DEEPER LIMUS study enrolled Rutherford class 3 to 5 patients with infrapopliteal artery disease. Patients underwent vessel preparation with retrievable scaffold therapy followed by sirolimus-coated balloon angioplasty. The primary safety outcome measure was a composite of all-cause mortality, major amputation, or clinically driven target lesion revascularization at 6 months. Secondary outcome measures included acute vessel recoil, perioperative death, angiographic late lumen loss between post-procedure and 6 months, as well as primary patency, major amputation, change in Rutherford class, and wound healing through 12 months.</p><p><strong>Results: </strong>The study included 26 patients (mean age 71 years, 62% male, 88% Rutherford 5) with 28 treated infrapopliteal lesions (36% occluded, 54% TASC B/C). Acute vessel recoil, measured in seven patients, was negligible (2.4 mm after treatment vs. 2.3 mm 15 minutes after deployment). A 6-month primary safety event occurred in 11.5% of patients (1 all-cause mortality, 1 major amputation, 1 clinically driven target lesion revascularization). Late lumen loss at 6 months was 0.7±0.7 mm. At 12 months, primary patency was 89.5%, improvement in Rutherford class was observed in 68.2% of patients, 90% of patients were deemed very low/low major limb amputation risk based on Wound, Ischemia, and foot Infection (WIfI) scores, and no additional major amputations or clinically driven target lesion revascularizations were reported.</p><p><strong>Conclusions: </strong>Retrievable scaffold therapy combined with sirolimus-coated balloon angioplasty demonstrated promising safety and efficacy through 12 months in patients with infrapopliteal artery disease.</p><p><strong>Level of evidence iv: </strong>Case Series.</p>","PeriodicalId":9591,"journal":{"name":"CardioVascular and Interventional Radiology","volume":" ","pages":"297-303"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited Commentary: Current Role of Splenic Artery Embolization in the Management of Blunt Splenic Injury.","authors":"Avinash Medsinge","doi":"10.1007/s00270-025-03973-4","DOIUrl":"10.1007/s00270-025-03973-4","url":null,"abstract":"","PeriodicalId":9591,"journal":{"name":"CardioVascular and Interventional Radiology","volume":" ","pages":"338-339"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Feasibility and Diagnostic Value of Percutaneous Transhepatic Cholangioscopy Biopsy for Biliary Strictures.","authors":"Nguyen Thai Binh, Phan Nhan Hien, Nguyen Truc Linh, Le Tuan Linh","doi":"10.1007/s00270-024-03954-z","DOIUrl":"10.1007/s00270-024-03954-z","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility and diagnostic value of percutaneous transhepatic cholangioscopy biopsy (PTCB) for identifying the causes of biliary strictures.</p><p><strong>Methods: </strong>This retrospective study included 34 patients (18 females and 16 males), with a mean age of 59.4 ± 13 years. The study population consisted of patients with suspected malignant biliary strictures on imaging or biliary lesions suspected of malignancy during percutaneous transhepatic endoscopic biliary lithotripsy (PTEBL). The final diagnosis for each patient was confirmed based on surgical pathology results, additional histopathological data, or through close clinical and imaging follow-up for at least one year.</p><p><strong>Results: </strong>Among the patients, 20 (58.9%) underwent PTCB alone, while 14 (41.1%) underwent PTCB combined with PTEBL. Biopsy locations included: 12 patients (35.3%) with intrahepatic bile duct, 12 patients (35.3%) with hilar bile duct, and 10 patients (29.4%) with common bile duct. Technical success of PTCB was defined as successful access to the biliary lesion, with the collection of an adequate histopathological tissue sample achieved in 100% of patients. The sensitivity, specificity, and accuracy of PTCB were 90%, 100%, and 97.1%, respectively. Minor complications were observed in 3 patients (8.8%).</p><p><strong>Conclusion: </strong>PTCB is a feasible and effective method for diagnosing the causes of biliary strictures, offering high sensitivity, specificity, and accuracy.</p>","PeriodicalId":9591,"journal":{"name":"CardioVascular and Interventional Radiology","volume":" ","pages":"364-371"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Embolization of Rectal Arteries for Treating Hemorrhoidal Disease Using a Combination of Microspheres and Microcoils: A Pilot Study.","authors":"Daniel Simões de Oliveira, José Américo Bacchi Hora, André Moreira de Assis, Airton Mota Moreira, Sérgio Carlos Nahas, Francisco César Carnevale","doi":"10.1007/s00270-024-03942-3","DOIUrl":"10.1007/s00270-024-03942-3","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the feasibility and initial results of superior (SRA) and middle (MRA) rectal artery embolization for patients with symptomatic hemorrhoidal disease.</p><p><strong>Materials and methods: </strong>Prospective, single-center cohort that included ten consecutive patients (Goligher classification was II in 70% and III in 30%.) who underwent SRA and MRA embolization using a combination of microspheres and metallic coils, who completed a follow-up period of 12 months. Technical success was defined as embolization of SRA and MRA whenever MRA dominance was observed. Clinical success was defined as an improvement of the hemorrhoid severity score (HSS) and quality of life (QoL) scores without recurrence, with the need for additional treatment. Procedure-related adverse events (AEs) were recorded and defined according to CIRSE classification as minor or major complications.</p><p><strong>Results: </strong>Technical success was achieved in all patients. SRA was embolized in 100% of patients and MRA in 80%. The improvement in HSS and QoL scores was 88% and 88% (p < 0.05), respectively, without clinical recurrence in the 12-month follow-up. One patient had a major complication (level D), a rectal ischemia and perforation of the rectosigmoid leading to perforative acute abdomen with sepsis that required surgical treatment (Hartmann's procedure).</p><p><strong>Conclusion: </strong>Embolization of both SRA-MRA using a combination of microspheres and metallic coils was feasible and significantly improved HSS and QoL scores. One major complication was observed and therefore it is essential to further investigate the safety boundaries of this technique.</p>","PeriodicalId":9591,"journal":{"name":"CardioVascular and Interventional Radiology","volume":" ","pages":"388-394"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-arterial Therapy Using Micellar Nanoparticles Incorporating SN-38 in a Rat Pancreatic Tumor Model.","authors":"Shinsaku Maeda, Takeshi Sato, Hideyuki Nishiofuku, Shohei Toyoda, Ryosuke Taiji, Takeshi Matsumoto, Yuto Chanoki, Tetsuya Tachiiri, Hideki Kunichika, Masayuki Sho, Toshihiro Tanaka","doi":"10.1007/s00270-024-03939-y","DOIUrl":"10.1007/s00270-024-03939-y","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate advantages of micellar nanoparticles encapsulating SN-38, a biologically active metabolite of irinotecan, in intraarterial therapy for pancreatic cancer.</p><p><strong>Materials and methods: </strong>Rat pancreatic cancer cells (DSL-6A/C1) were implanted in Lewis rats under laparotomy. This study consists of two parts. Firstly, after confirming tumor formation by ultrasonography, celiac arteriography was performed, and tumor blood supply was visually evaluated by dye injection and CT during arteriography. Secondly, 18 rats were divided into two groups; the Micellar Nanoparticles group and the Irinotecan Infusion group. Micellar nanoparticles or irinotecan was injected via the celiac artery, and SN-38 and irinotecan concentrations in the tumor, duodenum and pancreatic parenchyma, were measured at 5 min, 6 h and 24 h.</p><p><strong>Results: </strong>The maximum concentration (Cmax) of SN-38 were shown at 6 h in the Micellar Nanoparticles group, while Cmax of irinotecan was shown at 5 min in the Irinotecan Infusion group. Tumor concentration in the Micellar Nanoparticles group maintained elevated for 24 h without significant decrease (P = 0.068). Conversely, a significant decrease was observed in the regular pancreas parenchyma (P = 0.006) and duodenum (P = 0.028). In the Irinotecan Infusion group, tumor irinotecan concentration significantly decreased at 24 h (P = 0.016).</p><p><strong>Conclusion: </strong>Micellar nanoparticles may improve arterial infusion chemotherapy for pancreatic cancer. These nanoparticles have the potential to reduce SN-38 accumulation in duodenum, while increasing it in the tumor. Further research is warranted to validate and expand upon these findings.</p>","PeriodicalId":9591,"journal":{"name":"CardioVascular and Interventional Radiology","volume":" ","pages":"372-378"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous Biliary Neo-Anastomosis of Inadvertently Operatively Excluded Right Posterior Bile Ducts: A Durable and Highly Successful Procedure.","authors":"D Nakhostin, Henrik Petrowsky, G Puippe, A Kobe, T Pfammatter","doi":"10.1007/s00270-025-03977-0","DOIUrl":"10.1007/s00270-025-03977-0","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the feasibility and outcome of percutaneous biliary neo-anastomosis (PBNA) by means of fluoroscopy-guided enteral/biliary puncture, followed by temporary percutaneous transhepatic biliary drainage (PTBD).</p><p><strong>Materials and methods: </strong>Four patients (25% female, mean age 56 years) were referred for PBNA (bilio-entero-neo-anastomosis, n = 3; bilio-biliary-neo-anastomosis, n = 1) between 2007 and 2021. They presented with right posterior bile duct exclusion and bile leakage after major liver or pancreatic surgery, or hemiliver transplant. After puncture of the excluded/leaking bile duct, neo-anastomosis was performed under fluoroscopic guidance using the back end of a 0.018″ guidewire (n = 3) or a vascular reentry device (n = 1). PTBDs were inserted to assure PBNA healing.</p><p><strong>Results: </strong>Technical success rate was 100%. No complications occurred. All PTBDs were removed (median = 65 days). During a median follow-up of 2.8 years, two patients died due to unrelated causes. No subsequent bile leakages or re-occlusions were observed.</p><p><strong>Conclusion: </strong>In conclusion, PBNA is feasible and safe, and offers long-term biliary patency even in liver-transplanted patients.</p>","PeriodicalId":9591,"journal":{"name":"CardioVascular and Interventional Radiology","volume":" ","pages":"405-409"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}