{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T04:57:18Z","timestamp":1776488238652,"version":"3.51.2"},"reference-count":29,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Spinal osteotomy in pediatric patients is challenging due to various factors. For correction of severe rigid kyphoscoliosis in children, numerous techniques with anterior or posterior or combined approaches, as well as multilevel osteotomies, have been described. These techniques are associated with prolonged operative times and large amounts of blood loss. The purpose of this study was to evaluate the clinical and radiologically confirmed efficacy of a modification of the apical spinal osteotomy (ASO) technique\u2014posterior-only single-level asymmetric closing osteotomy\u2014in pediatric patients with severe rigid kyphoscoliosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors performed a retrospective study of a case series involving pediatric patients with severe spinal deformity operated on by a single surgeon at a single institution over a period of approximately 5 years. The inclusion criteria were age &lt; 14 years, rigid thoracic\/thoracolumbar\/lumbar kyphosis (&gt; 70\u00b0) with or without neurological deficit and with or without scoliosis, and a minimum of 2 years of follow-up. Patients with cervical or lumbosacral kyphoscoliosis were excluded from the study. Demographic and clinical parameters, including age, sex, etiology of kyphoscoliosis, neurological examination status (Frankel grade), and visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, were noted. Operative parameters (level of osteotomy, number of levels fused, duration of surgery, blood loss, and complications) were also recorded. Radiological assessment was done for preoperative and postoperative kyphosis and scoliosis as well as the final Cobb angle. Similarly, sagittal vertical axis (SVA) correction was calculated. Fusion was assessed in all patients at the final follow-up evaluation.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>A total of 26 pediatric patients (18 male and 8 female) with a mean age of 9 years met the inclusion criteria and had data available for analysis, and all of these patients had severe scoliosis as well as kyphosis. Comparison of preoperative and postoperative values showed a significant improvement (p &lt; 0.05) in radiological, clinical, and functional parameters (Cobb angle for scoliosis and kyphosis, SVA, VAS, and ODI). With respect to kyphosis, the mean preoperative Cobb angle was 96.54\u00b0, the mean postoperative angle was 30.77\u00b0, and the mean angle at final follow-up was 34.81\u00b0 (average loss of correction of 4.23\u00b0), for a final average correction of 64.15%. With respect to scoliosis, the mean preoperative angle was 52.54\u00b0, the mean postoperative angle was 15.77\u00b0, and the mean angle at final follow-up was 19.42\u00b0 (average loss of correction of 3.66\u00b0), for a final average correction of 60.95%. The preoperative SVA averaged 7.6 cm; the mean SVA improved to 3.94 cm at the end of 2 years. Bony fusion was achieved in all patients. The mean number of levels fused was 5.69. The mean operative time was 243.46 minutes, with an average intraoperative blood loss of 336.92 ml. Nonneurological complications occurred in 15.39% of patients (2 dural tears, 1 superficial infection, 1 implant failure). At the 2-year follow-up, 25 of the 26 patients had maintained or improved their neurological status. One patient developed paraplegia immediately after the operation and recovered only partially.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Analysis of data from this series of 26 cases indicates that this posterior-approach single-level technique is effective for the correction of severe rigid kyphoscoliosis in pediatric patients, providing good clinical and radiological results in most cases.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2017.12.peds17404","type":"journal-article","created":{"date-parts":[[2018,3,30]],"date-time":"2018-03-30T13:55:30Z","timestamp":1522418130000},"page":"606-614","source":"Crossref","is-referenced-by-count":15,"title":["Posterior-approach single-level apical spinal osteotomy in pediatric patients for severe rigid kyphoscoliosis: long-term clinical and radiological outcomes"],"prefix":"10.3171","volume":"21","author":[{"given":"Ankit","family":"Patel","sequence":"first","affiliation":[{"name":"Bombay Hospital, Mumbai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sameer","family":"Ruparel","sequence":"additional","affiliation":[{"name":"Bombay Hospital, Mumbai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tarun","family":"Dusad","sequence":"additional","affiliation":[{"name":"Bombay Hospital, Mumbai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaurav","family":"Mehta","sequence":"additional","affiliation":[{"name":"Bombay Hospital, Mumbai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vishal","family":"Kundnani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"Suppl 1","key":"b1","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"S95","DOI":"10.1007\/s00586-011-1749-y","article-title":"Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities","volume":"20","author":"Bakaloudis G","year":"2011","unstructured":"Bakaloudis G, Lolli F, Di Silvestre M, Greggi T, Astolfi S, Martikos K, : Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities. Eur Spine J 20 (Suppl 1):S95\u2013S104, 201110.1007\/s00586-011-1749-y"},{"key":"b2","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2036","DOI":"10.1097\/00007632-200109150-00020","article-title":"Management of fixed sagittal plane deformity: results of the transpedicular wedge resection osteotomy","volume":"26","author":"Berven SH","year":"2001","unstructured":"Berven SH, Deviren V, Smith JA, Emami A, Hu SS, Bradford DS: Management of fixed sagittal plane deformity: results of the transpedicular wedge resection osteotomy. Spine (Phila Pa 1976) 26:2036\u20132043, 200110.1097\/00007632-200109150-0002011547205"},{"key":"b3","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1712","DOI":"10.1097\/00007632-199908150-00013","article-title":"Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance)","volume":"24","author":"Booth KC","year":"1999","unstructured":"Booth KC, Bridwell KH, Lenke LG, Baldus CR, Blanke KM: Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance). Spine (Phila Pa 1976) 24:1712\u20131720, 19991047210610.1097\/00007632-199908150-00013"},{"key":"b4","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2617","DOI":"10.1097\/00007632-199912150-00009","article-title":"Adult scoliosis: surgical indications, operative management, complications, and outcomes","volume":"24","author":"Bradford DS","year":"1999","unstructured":"Bradford DS, Tay BK, Hu SS: Adult scoliosis: surgical indications, operative management, complications, and outcomes. Spine (Phila Pa 1976) 24:2617\u20132629, 199910.1097\/00007632-199912150-0000910635525"},{"issue":"19 Suppl","key":"b5","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"S171","DOI":"10.1097\/01.brs.0000188190.90034.be","article-title":"Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity","volume":"31","author":"Bridwell KH","year":"2006","unstructured":"Bridwell KH: Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine (Phila Pa 1976) 31 (19 Suppl):S171\u2013S178, 200610.1097\/01.brs.0000188190.90034.be"},{"key":"b6","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"454","DOI":"10.2106\/00004623-200303000-00009","article-title":"Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance","volume":"85-A","author":"Bridwell KH","year":"2003","unstructured":"Bridwell KH, Lewis SJ, Lenke LG, Baldus C, Blanke K: Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg Am 85-A:454\u2013463, 200310.2106\/00004623-200303000-0000912637431"},{"key":"b7","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1674","DOI":"10.1097\/01.brs.0000170450.77554.bc","article-title":"Apical lordosating osteotomy and minimal segment fixation for the treatment of thoracic or thoracolumbar osteoporotic kyphosis","volume":"30","author":"Chang KW","year":"2005","unstructured":"Chang KW, Chen YY, Lin CC, Hsu HL, Pai KC: Apical lordosating osteotomy and minimal segment fixation for the treatment of thoracic or thoracolumbar osteoporotic kyphosis. Spine (Phila Pa 1976) 30:1674\u20131681, 200510.1097\/01.brs.0000170450.77554.bc16025040"},{"key":"b8","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1470","DOI":"10.1097\/BRS.0b013e3181753bcd","article-title":"Closing-opening wedge osteotomy for the treatment of sagittal imbalance","volume":"33","author":"Chang KW","year":"2008","unstructured":"Chang KW, Cheng CW, Chen HC, Chang KI, Chen TC: Closing-opening wedge osteotomy for the treatment of sagittal imbalance. Spine (Phila Pa 1976) 33:1470\u20131477, 20081852094310.1097\/BRS.0b013e3181753bcd"},{"key":"b9","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1097\/BRS.0b013e31816f5f73","article-title":"Loss of spinal cord monitoring signals in children during thoracic kyphosis correction with spinal osteotomy: why does it occur and what should you do?","volume":"33","author":"Cheh G","year":"2008","unstructured":"Cheh G, Lenke LG, Padberg AM, Kim YJ, Daubs MD, Kuhns C, : Loss of spinal cord monitoring signals in children during thoracic kyphosis correction with spinal osteotomy: why does it occur and what should you do? Spine (Phila Pa 1976) 33:1093\u20131099, 200810.1097\/BRS.0b013e31816f5f73"},{"key":"b10","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"106","DOI":"10.3171\/2010.9.SPINE10257","article-title":"Apical segmental resection osteotomy with dual axial rotation corrective technique for severe focal kyphosis of the thoracolumbar spine","volume":"14","author":"Chen Z","year":"2011","unstructured":"Chen Z, Zeng Y, Li W, Guo Z, Qi Q, Sun C: Apical segmental resection osteotomy with dual axial rotation corrective technique for severe focal kyphosis of the thoracolumbar spine. J Neurosurg Spine 14:106\u2013113, 201110.3171\/2010.9.SPINE1025721142456"},{"key":"b11","series-title":"J Pediatr Orthop","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1097\/01241398-198909010-00008","article-title":"The crankshaft phenomenon","volume":"9","author":"Dubousset J","year":"1989","unstructured":"Dubousset J, Herring JA, Shufflebarger H: The crankshaft phenomenon. J Pediatr Orthop 9:541\u2013550, 198910.1097\/01241398-198909010-000082794027"},{"key":"b12","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1097\/00007632-199203000-00025","article-title":"Wedge osteotomy for the correction of posttraumatic. kyphosis","volume":"17","author":"Gertzbein SD","year":"1992","unstructured":"Gertzbein SD, Harris MB: Wedge osteotomy for the correction of posttraumatic. kyphosis. Spine (Phila Pa 1976) 17:374\u2013379, 199210.1097\/00007632-199203000-00025"},{"key":"b13","series-title":"J Bone Joint Surg Br","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1302\/0301-620X.88B7.17366","article-title":"Pedicle subtraction osteotomy for rigid post-tuberculous kyphosis","volume":"88","author":"Kalra KP","year":"2006","unstructured":"Kalra KP, Dhar SB, Shetty G, Dhariwal Q: Pedicle subtraction osteotomy for rigid post-tuberculous kyphosis. J Bone Joint Surg Br 88:925\u2013927, 20061679899710.1302\/0301-620X.88B7.17366"},{"key":"b14","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1097\/00007632-200102150-00016","article-title":"Closing-opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach","volume":"26","author":"Kawahara N","year":"2001","unstructured":"Kawahara N, Tomita K, Baba H, Kobayashi T, Fujita T, Murakami H: Closing-opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach. Spine (Phila Pa 1976) 26:391\u2013402, 20011122488710.1097\/00007632-200102150-00016"},{"key":"b15","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1667","DOI":"10.1097\/BRS.0b013e3182552fd0","article-title":"Outcome of pedicle subtraction osteotomies for fixed sagittal imbalance of multiple etiologies: a retrospective review of 140 patients","volume":"37","author":"Kim KT","year":"2012","unstructured":"Kim KT, Lee SH, Suk KS, Lee JH, Jeong BO: Outcome of pedicle subtraction osteotomies for fixed sagittal imbalance of multiple etiologies: a retrospective review of 140 patients. Spine (Phila Pa 1976) 37:1667\u20131675, 201210.1097\/BRS.0b013e3182552fd022433502"},{"key":"b16","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2189","DOI":"10.1097\/BRS.0b013e31814b8371","article-title":"Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study","volume":"32","author":"Kim YJ","year":"2007","unstructured":"Kim YJ, Bridwell KH, Lenke LG, Cheh G, Baldus C: Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976) 32:2189\u20132197, 200710.1097\/BRS.0b013e31814b837117873810"},{"key":"b17","series-title":"J Bone Joint Surg Am","first-page":"1534","article-title":"Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure","volume":"87","author":"Kim YJ","year":"2005","unstructured":"Kim YJ, Lenke LG, Bridwell KH, Kim KL, Steger-May K: Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure. J Bone Joint Surg Am 87:1534\u20131541, 200515995121"},{"key":"b18","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2060","DOI":"10.1097\/00007632-199409150-00009","article-title":"Posterior transvertebral osteotomy for adult thoracolumbar kyphosis","volume":"19","author":"Lehmer SM","year":"1994","unstructured":"Lehmer SM, Keppler L, Biscup RS, Enker P, Miller SD, Steffee AD: Posterior transvertebral osteotomy for adult thoracolumbar kyphosis. Spine (Phila Pa 1976) 19:2060\u20132067, 199410.1097\/00007632-199409150-000097825046"},{"key":"b19","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2055","DOI":"10.1097\/01.brs.0000138274.09504.38","article-title":"Prospective pulmonary function comparison of open versus endoscopic anterior fusion combined with posterior fusion in adolescent idiopathic scoliosis","volume":"29","author":"Lenke LG","year":"2004","unstructured":"Lenke LG, Newton PO, Marks MC, Blanke KM, Sides B, Kim YJ, : Prospective pulmonary function comparison of open versus endoscopic anterior fusion combined with posterior fusion in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 29:2055\u20132060, 20041537170810.1097\/01.brs.0000138274.09504.38"},{"key":"b20","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1097\/BRS.0b013e318269fab1","article-title":"Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis","volume":"38","author":"Lenke LG","year":"2013","unstructured":"Lenke LG, Newton PO, Sucato DJ, Shufflebarger HL, Emans JB, Sponseller PD, : Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Spine (Phila Pa 1976) 38:119\u2013132, 201310.1097\/BRS.0b013e318269fab122825478"},{"key":"b21","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2213","DOI":"10.1097\/BRS.0b013e3181b53cba","article-title":"Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients","volume":"34","author":"Lenke LG","year":"2009","unstructured":"Lenke LG, O\u2019Leary PT, Bridwell KH, Sides BA, Koester LA, Blanke KM: Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients. Spine (Phila Pa 1976) 34:2213\u20132221, 200910.1097\/BRS.0b013e3181b53cba19752708"},{"key":"b22","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2061","DOI":"10.1097\/01.brs.0000179299.78791.96","article-title":"Thoracic adolescent idiopathic scoliosis curves between 70 degrees and 100 degrees: is anterior release necessary?","volume":"30","author":"Luhmann SJ","year":"2005","unstructured":"Luhmann SJ, Lenke LG, Kim YJ, Bridwell KH, Schootman M: Thoracic adolescent idiopathic scoliosis curves between 70 degrees and 100 degrees: is anterior release necessary? Spine (Phila Pa 1976) 30:2061\u20132067, 20051616689610.1097\/01.brs.0000179299.78791.96"},{"key":"b23","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2260","DOI":"10.1097\/00007632-200210150-00015","article-title":"Spinal wedge osteotomy by a single posterior approach for correction of severe and rigid kyphosis or kyphoscoliosis","volume":"27","author":"Shimode M","year":"2002","unstructured":"Shimode M, Kojima T, Sowa K: Spinal wedge osteotomy by a single posterior approach for correction of severe and rigid kyphosis or kyphoscoliosis. Spine (Phila Pa 1976) 27:2260\u20132267, 20021239490410.1097\/00007632-200210150-00015"},{"key":"b24","series-title":"Spine (Phila Pa 1976)","first-page":"E655","article-title":"Vertebral column resection in children with neuromuscular spine deformity","volume":"37","author":"Sponseller PD","year":"2012","unstructured":"Sponseller PD, Jain A, Lenke LG, Shah SA, Sucato DJ, Emans JB, : Vertebral column resection in children with neuromuscular spine deformity. Spine (Phila Pa 1976) 37:E655\u2013E661, 2012"},{"key":"b25","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1682","DOI":"10.1097\/01.brs.0000170590.21071.c1","article-title":"Posterior vertebral column resection for severe rigid scoliosis","volume":"30","author":"Suk SI","year":"2005","unstructured":"Suk SI, Chung ER, Kim JH, Kim SS, Lee JS, Choi WK: Posterior vertebral column resection for severe rigid scoliosis. Spine (Phila Pa 1976) 30:1682\u20131687, 20051602504110.1097\/01.brs.0000170590.21071.c1"},{"key":"b26","series-title":"Spine (Phila Pa 1976)","first-page":"E703","article-title":"Posterior vertebral column resection in fixed lumbosacral deformity","volume":"30","author":"Suk SI","year":"2005","unstructured":"Suk SI, Chung ER, Lee SM, Lee JH, Kim SS, Kim JH: Posterior vertebral column resection in fixed lumbosacral deformity. Spine (Phila Pa 1976) 30:E703\u2013E710, 2005"},{"key":"b27","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2374","DOI":"10.1097\/00007632-200211010-00012","article-title":"Posterior vertebral column resection for severe spinal deformities","volume":"27","author":"Suk SI","year":"2002","unstructured":"Suk SI, Kim JH, Kim WJ, Lee SM, Chung ER, Nah KH: Posterior vertebral column resection for severe spinal deformities. Spine (Phila Pa 1976) 27:2374\u20132382, 20021243898710.1097\/00007632-200211010-00012"},{"key":"b28","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"1703","DOI":"10.1007\/s00586-011-1771-0","article-title":"Vertebral column decancellation for the management of sharp angular spinal deformity","volume":"20","author":"Wang Y","year":"2011","unstructured":"Wang Y, Lenke LG: Vertebral column decancellation for the management of sharp angular spinal deformity. Eur Spine J 20:1703\u20131710, 201110.1007\/s00586-011-1771-021424339"},{"key":"b29","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1007\/s00586-007-0566-9","article-title":"A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases","volume":"17","author":"Wang Y","year":"2008","unstructured":"Wang Y, Zhang Y, Zhang X, Huang P, Xiao S, Wang Z, : A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases. Eur Spine J 17:361\u2013372, 200810.1007\/s00586-007-0566-918172699"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/21\/6\/article-p606.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/21\/6\/article-p606.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/21\/6\/article-p606.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T13:48:18Z","timestamp":1681566498000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/21\/6\/article-p606.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6]]},"references-count":29,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2017.12.peds17404","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6]]}}}