{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T03:04:36Z","timestamp":1792638276094,"version":"4.5.0"},"reference-count":37,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Little is known about the relationship between postoperative changes in cerebral perfusion and the ivy sign representing leptomeningeal collateral burden in moyamoya disease (MMD). This study aimed to investigate the usefulness of the ivy sign in evaluating cerebral perfusion status following bypass surgery in patients with adult MMD.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Two hundred thirty-three hemispheres in 192 patients with adult MMD undergoing combined bypass between 2010 and 2018 were retrospectively enrolled. The ivy sign was represented as the ivy score on FLAIR MRI in each territory of the anterior, middle, and posterior cerebral arteries. Ivy scores, as well as clinical and hemodynamic states on SPECT, were semiquantitatively compared both preoperatively and at 6 months after surgery.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Clinical status improved at 6 months after surgery (p < 0.01). On average, ivy scores in whole and individual territories were decreased at 6 months (all p values < 0.01). Cerebral blood flow (CBF) postoperatively improved in three individual vascular territories (all p values \u2264 0.03) except for the posterior cerebral artery territory (PCAt), and cerebrovascular reserve (CVR) improved in those areas (all p values \u2264 0.04) except for the PCAt. Postoperative changes in ivy scores and CBF were inversely correlated in all territories (p \u2264 0.02), except for the PCAt. Furthermore, changes in ivy scores and CVR were only correlated in the posterior half of the middle cerebral artery territory (p = 0.01).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The ivy sign was significantly decreased after bypass surgery, which was well correlated with postoperative hemodynamic improvement in the anterior circulation territories. The ivy sign is believed to be a useful radiological marker for postoperative follow-up of cerebral perfusion status.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2023.4.jns23294","type":"journal-article","created":{"date-parts":[[2023,6,3]],"date-time":"2023-06-03T11:33:11Z","timestamp":1685791991000},"page":"1697-1704","source":"Crossref","is-referenced-by-count":9,"title":["The ivy sign as a radiological marker for follow-up of postoperative cerebral perfusion status in adult moyamoya disease"],"prefix":"10.3171","volume":"139","author":[{"given":"Sung Ho","family":"Lee","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Won-Sang","family":"Cho","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee Chang","family":"Lee","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hansan","family":"Oh","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Woo","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Inha University School of Medicine, Incheon; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Hoon","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Seoul Metropolitan Government\u2013Seoul National University Boramae Medical Center, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Chul","family":"Paeng","sequence":"additional","affiliation":[{"name":"Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joonhyung","family":"Gil","sequence":"additional","affiliation":[{"name":"Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kangmin","family":"Kim","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun-Seung","family":"Kang","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong Eun","family":"Kim","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"12","key":"b1","series-title":"N Engl J Med","first-page":"1226","article-title":"Moyamoya disease and moyamoya syndrome","volume":"360","author":"Scott RM","year":"2009","unstructured":"Scott RM, Smith ER. Moyamoya disease and moyamoya syndrome. N Engl J Med. 2009;360(12):1226\u20131237."},{"issue":"1","key":"b2","series-title":"Stroke","first-page":"104","article-title":"Moyamoya disease\u2014a review","volume":"14","author":"Suzuki J","year":"1983","unstructured":"Suzuki J, Kodama N. Moyamoya disease\u2014a review. Stroke. 1983;14(1):104\u2013109."},{"issue":"1","key":"b3","series-title":"Sci Rep","first-page":"19367","article-title":"Benefits and risks of antiplatelet medication in hemodynamically stable adult moyamoya disease","volume":"11","author":"Pang CH","year":"2021","unstructured":"Pang CH, Cho WS, Kang HS, Kim JE. Benefits and risks of antiplatelet medication in hemodynamically stable adult moyamoya disease. Sci Rep. 2021;11(1):19367."},{"issue":"6","key":"b4","series-title":"J Neurosurg","first-page":"1788","article-title":"Stroke prevention by direct revascularization for patients with adult-onset moyamoya disease presenting with ischemia","volume":"124","author":"Kim T","year":"2016","unstructured":"Kim T, Oh CW, Kwon OK, Stroke prevention by direct revascularization for patients with adult-onset moyamoya disease presenting with ischemia. J Neurosurg. 2016;124(6):1788\u20131793."},{"issue":"5","key":"b5","series-title":"Stroke","first-page":"1415","article-title":"Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial","volume":"45","author":"Miyamoto S","year":"2014","unstructured":"Miyamoto S, Yoshimoto T, Hashimoto N, Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial. Stroke. 2014;45(5):1415\u20131421."},{"issue":"2","key":"b6","series-title":"Neurosurgery","first-page":"289","article-title":"Natural history and risk factor of recurrent hemorrhage in hemorrhagic adult moyamoya disease","volume":"81","author":"Kim KM","year":"2017","unstructured":"Kim KM, Kim JE, Cho WS, Natural history and risk factor of recurrent hemorrhage in hemorrhagic adult moyamoya disease. Neurosurgery. 2017;81(2):289\u2013296."},{"issue":"10","key":"b7","series-title":"Stroke","first-page":"3025","article-title":"Long-term outcomes after combined revascularization surgery in adult moyamoya disease","volume":"45","author":"Cho WS","year":"2014","unstructured":"Cho WS, Kim JE, Kim CH, Long-term outcomes after combined revascularization surgery in adult moyamoya disease. Stroke. 2014;45(10):3025\u20133031."},{"issue":"1-2","key":"b8","series-title":"J Neurol Sci","first-page":"381","article-title":"Long term outcome and predictors of ischemic stroke recurrence in adult moyamoya disease","volume":"359","author":"Noh HJ","year":"2015","unstructured":"Noh HJ, Kim SJ, Kim JS, Long term outcome and predictors of ischemic stroke recurrence in adult moyamoya disease. J Neurol Sci. 2015;359(1-2):381\u2013388."},{"issue":"7","key":"b9","series-title":"Acta Neurochir (Wien)","first-page":"1179","article-title":"Long-term follow-up results in 142 adult patients with moyamoya disease according to management modality","volume":"154","author":"Lee SB","year":"2012","unstructured":"Lee SB, Kim DS, Huh PW, Yoo DS, Lee TG, Cho KS. Long-term follow-up results in 142 adult patients with moyamoya disease according to management modality. Acta Neurochir (Wien). 2012;154(7):1179\u20131187."},{"issue":"6","key":"b10","series-title":"Eur J Neurol","first-page":"609","article-title":"Acetazolamide as a vasodilatory stimulus in cerebrovascular diseases and in conditions affecting the cerebral vasculature","volume":"10","author":"Settakis G","year":"2003","unstructured":"Settakis G, Moln\u00e1r C, Ker\u00e9nyi L, Acetazolamide as a vasodilatory stimulus in cerebrovascular diseases and in conditions affecting the cerebral vasculature. Eur J Neurol. 2003;10(6):609\u2013620."},{"issue":"7","key":"b11","series-title":"Neurol Med Chir (Tokyo)","first-page":"479","article-title":"Adverse effects of intravenous acetazolamide administration for evaluation of cerebrovascular reactivity using brain perfusion single-photon emission computed tomography in patients with major cerebral artery steno-occlusive diseases","volume":"51","author":"Saito H","year":"2011","unstructured":"Saito H, Ogasawara K, Suzuki T, Adverse effects of intravenous acetazolamide administration for evaluation of cerebrovascular reactivity using brain perfusion single-photon emission computed tomography in patients with major cerebral artery steno-occlusive diseases. Neurol Med Chir (Tokyo). 2011;51(7):479\u2013483."},{"issue":"11","key":"b12","series-title":"Childs Nerv Syst","first-page":"2029","article-title":"Extensive brain infarction involving deep structures during an acetazolamide-challenged single-photon emission computed tomography scan in a patient with moyamoya disease","volume":"33","author":"Chong S","year":"2017","unstructured":"Chong S, Park JD, Chae JH, Extensive brain infarction involving deep structures during an acetazolamide-challenged single-photon emission computed tomography scan in a patient with moyamoya disease. Childs Nerv Syst. 2017;33(11):2029\u20132033."},{"issue":"5","key":"b13","series-title":"AJNR Am J Neuroradiol","first-page":"930","article-title":"The leptomeningeal \"ivy sign\" on fluid-attenuated inversion recovery MR imaging in Moyamoya disease: a sign of decreased cerebral vascular reserve?","volume":"30","author":"Mori N","year":"2009","unstructured":"Mori N, Mugikura S, Higano S, The leptomeningeal \"ivy sign\" on fluid-attenuated inversion recovery MR imaging in Moyamoya disease: a sign of decreased cerebral vascular reserve? AJNR Am J Neuroradiol. 2009;30(5):930\u2013935."},{"issue":"5-6","key":"b14","series-title":"Cerebrovasc Dis","first-page":"223","article-title":"Ivy sign predicts ischemic stroke recurrence in adult moyamoya patients without revascularization surgery","volume":"47","author":"Nam KW","year":"2019","unstructured":"Nam KW, Cho WS, Kwon HM, Ivy sign predicts ischemic stroke recurrence in adult moyamoya patients without revascularization surgery. Cerebrovasc Dis. 2019;47(5-6):223\u2013230."},{"issue":"2","key":"b15","series-title":"Eur J Radiol","first-page":"224","article-title":"Leptomeningeal high signal intensity (ivy sign) on fluid-attenuated inversion-recovery (FLAIR) MR images in moyamoya disease","volume":"55","author":"Fujiwara H","year":"2005","unstructured":"Fujiwara H, Momoshima S, Kuribayashi S. Leptomeningeal high signal intensity (ivy sign) on fluid-attenuated inversion-recovery (FLAIR) MR images in moyamoya disease. Eur J Radiol. 2005;55(2):224\u2013230."},{"issue":"5","key":"b16","series-title":"Yonsei Med J","first-page":"1322","article-title":"Ivy sign on fluid-attenuated inversion recovery images in moyamoya disease: correlation with clinical severity and old brain lesions","volume":"56","author":"Seo KD","year":"2015","unstructured":"Seo KD, Suh SH, Kim YB, Ivy sign on fluid-attenuated inversion recovery images in moyamoya disease: correlation with clinical severity and old brain lesions. Yonsei Med J. 2015;56(5):1322\u20131327."},{"issue":"4","key":"b17","series-title":"J Neurosurg Pediatr","first-page":"458","article-title":"Ivy sign: a diagnostic and prognostic biomarker for pediatric moyamoya","volume":"29","author":"Montaser AS","year":"2021","unstructured":"Montaser AS, Lalgudi Srinivasan H, Staffa SJ, Ivy sign: a diagnostic and prognostic biomarker for pediatric moyamoya. J Neurosurg Pediatr. 2021;29(4):458\u2013466."},{"issue":"9","key":"b18","series-title":"AJNR Am J Neuroradiol","first-page":"1713","article-title":"Decrease in leptomeningeal ivy sign on fluid-attenuated inversion recovery images after cerebral revascularization in patients with moyamoya disease","volume":"31","author":"Kawashima M","year":"2010","unstructured":"Kawashima M, Noguchi T, Takase Y, Nakahara Y, Matsushima T. Decrease in leptomeningeal ivy sign on fluid-attenuated inversion recovery images after cerebral revascularization in patients with moyamoya disease. AJNR Am J Neuroradiol. 2010;31(9):1713\u20131718."},{"issue":"3","key":"b19","series-title":"Acta Radiol","first-page":"291","article-title":"Ivy signs on FLAIR images before and after STA-MCA anastomosis in patients with moyamoya disease","volume":"52","author":"Ideguchi R","year":"2011","unstructured":"Ideguchi R, Morikawa M, Enokizono M, Ogawa Y, Nagata I, Uetani M. Ivy signs on FLAIR images before and after STA-MCA anastomosis in patients with moyamoya disease. Acta Radiol. 2011;52(3):291\u2013296."},{"issue":"4","key":"b20","series-title":"J Korean Neurosurg Soc","first-page":"302","article-title":"The usefulness of the ivy sign on fluid-attenuated intensity recovery images in improved brain hemodynamic changes after superficial temporal artery-middle cerebral artery anastomosis in adult patients with moyamoya disease","volume":"54","author":"Lee JK","year":"2013","unstructured":"Lee JK, Yoon BH, Chung SY, Park MS, Kim SM, Lee DS. The usefulness of the ivy sign on fluid-attenuated intensity recovery images in improved brain hemodynamic changes after superficial temporal artery-middle cerebral artery anastomosis in adult patients with moyamoya disease. J Korean Neurosurg Soc. 2013;54(4):302\u2013308."},{"issue":"5","key":"b21","series-title":"Neurol Res","first-page":"407","article-title":"An update on the diagnosis and treatment of adult moyamoya disease taking into consideration controversial issues","volume":"36","author":"Kim JE","year":"2014","unstructured":"Kim JE, Jeon JS. An update on the diagnosis and treatment of adult moyamoya disease taking into consideration controversial issues. Neurol Res. 2014;36(5):407\u2013416."},{"issue":"11","key":"b22","series-title":"J Korean Med Assoc","first-page":"577","article-title":"Diagnosis and treatment of adult moyamoya disease","volume":"62","author":"Kim JE","year":"2019","unstructured":"Kim JE, Pang CH. Diagnosis and treatment of adult moyamoya disease. J Korean Med Assoc. 2019;62(11):577\u2013585."},{"issue":"5","key":"b23","series-title":"Neurol Med Chir (Tokyo)","first-page":"311","article-title":"Clinical features of adult moyamoya disease with special reference to the diagnosis","volume":"52","author":"Kim JE","year":"2012","unstructured":"Kim JE, Kim KM, Kim JG, Clinical features of adult moyamoya disease with special reference to the diagnosis. Neurol Med Chir (Tokyo). 2012;52(5):311\u2013317."},{"issue":"5","key":"b24","series-title":"Neurol Med Chir (Tokyo)","first-page":"245","article-title":"Research Committee on the Pathology and Treatment of Spontaneous Occlusion of the Circle of Willis; Health Labour Sciences Research Grant for Research on Measures for Infractable Diseases. Guidelines for diagnosis and treatment of moyamoya disease (spontaneous occlusion of the circle of Willis)","volume":"52","year":"2012","unstructured":"Research Committee on the Pathology and Treatment of Spontaneous Occlusion of the Circle of Willis; Health Labour Sciences Research Grant for Research on Measures for Infractable Diseases. Guidelines for diagnosis and treatment of moyamoya disease (spontaneous occlusion of the circle of Willis). Neurol Med Chir (Tokyo). 2012;52(5):245\u2013266."},{"issue":"9","key":"b25","series-title":"Stroke","first-page":"1984","article-title":"Optimizing cutoff scores for the Barthel index and the modified Rankin scale for defining outcome in acute stroke trials","volume":"36","author":"Uyttenboogaart M","year":"2005","unstructured":"Uyttenboogaart M, Stewart RE, Vroomen PC, De Keyser J, Luijckx GJ. Optimizing cutoff scores for the Barthel index and the modified Rankin scale for defining outcome in acute stroke trials. Stroke. 2005;36(9):1984\u20131987."},{"issue":"1","key":"b26","series-title":"J Nucl Med","first-page":"39","article-title":"Probabilistic anatomic mapping of cerebral blood flow distribution of the middle cerebral artery","volume":"49","author":"Kim SJ","year":"2008","unstructured":"Kim SJ, Kim IJ, Kim YK, Probabilistic anatomic mapping of cerebral blood flow distribution of the middle cerebral artery. J Nucl Med. 2008;49(1):39\u201343."},{"issue":"4","key":"b27","series-title":"Neuroimage","first-page":"1422","article-title":"Probabilistic map of blood flow distribution in the brain from the internal carotid artery","volume":"23","author":"Lee JS","year":"2004","unstructured":"Lee JS, Lee DS, Kim YK, Probabilistic map of blood flow distribution in the brain from the internal carotid artery. Neuroimage. 2004;23(4):1422\u20131431."},{"issue":"5","key":"b28","series-title":"Neurosurgery","first-page":"1009","article-title":"Diffuse leptomeningeal enhancement, \"ivy sign,\" in magnetic resonance images of moyamoya disease in childhood: case report","volume":"37","author":"Ohta T","year":"1995","unstructured":"Ohta T, Tanaka H, Kuroiwa T. Diffuse leptomeningeal enhancement, \"ivy sign,\" in magnetic resonance images of moyamoya disease in childhood: case report. Neurosurgery. 1995;37(5):1009\u20131012."},{"issue":"10","key":"b29","series-title":"AJNR Am J Neuroradiol","first-page":"1836","article-title":"\"Ivy sign\" on fluid-attenuated inversion-recovery images in childhood moyamoya disease","volume":"20","author":"Maeda M","year":"1999","unstructured":"Maeda M, Tsuchida C. \"Ivy sign\" on fluid-attenuated inversion-recovery images in childhood moyamoya disease. AJNR Am J Neuroradiol. 1999;20(10):1836\u20131838."},{"issue":"1","key":"b30","series-title":"Cerebrovasc Dis","first-page":"19","article-title":"The leptomeningeal ivy sign on fluid-attenuated inversion recovery images in moyamoya disease: positron emission tomography study","volume":"36","author":"Kaku Y","year":"2013","unstructured":"Kaku Y, Iihara K, Nakajima N, The leptomeningeal ivy sign on fluid-attenuated inversion recovery images in moyamoya disease: positron emission tomography study. Cerebrovasc Dis. 2013;36(1):19\u201325."},{"issue":"2","key":"b31","series-title":"Radiology","first-page":"384","article-title":"\"Ivy sign\" in childhood moyamoya disease: depiction on FLAIR and contrast-enhanced T1-weighted MR images","volume":"223","author":"Yoon HK","year":"2002","unstructured":"Yoon HK, Shin HJ, Chang YW. \"Ivy sign\" in childhood moyamoya disease: depiction on FLAIR and contrast-enhanced T1-weighted MR images. Radiology. 2002;223(2):384\u2013389."},{"issue":"suppl 2","key":"b32","series-title":"Clin Neurol Neurosurg","first-page":"S209","article-title":"Histopathological studies on spontaneous vault moyamoya and revascularized collaterals formed by encephalomyosynangiosis","volume":"99","author":"Kono S","year":"1997","unstructured":"Kono S, Oka K, Sueishi K, Sonobe M. Histopathological studies on spontaneous vault moyamoya and revascularized collaterals formed by encephalomyosynangiosis. Clin Neurol Neurosurg. 1997;99(suppl 2):S209-S212."},{"issue":"4","key":"b33","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Quantitative hemodynamic studies in moyamoya disease: a review","volume":"26","author":"Lee M","year":"2009","unstructured":"Lee M, Zaharchuk G, Guzman R, Achrol A, Bell-Stephens T, Steinberg GK. Quantitative hemodynamic studies in moyamoya disease: a review. Neurosurg Focus. 2009;26(4):E5."},{"issue":"suppl 2","key":"b34","series-title":"Clin Neurol Neurosurg","first-page":"S74","article-title":"Cerebral hemodynamics and metabolism in moyamoya disease\u2014a positron emission tomography study","volume":"99","author":"Kuwabara Y","year":"1997","unstructured":"Kuwabara Y, Ichiya Y, Sasaki M, Cerebral hemodynamics and metabolism in moyamoya disease\u2014a positron emission tomography study. Clin Neurol Neurosurg. 1997;99(suppl 2):S74-S78."},{"issue":"1","key":"b35","series-title":"Radiology","first-page":"53","article-title":"Cerebral blood flow: measurement with xenon-enhanced dynamic helical CT","volume":"195","author":"Nambu K","year":"1995","unstructured":"Nambu K, Suzuki R, Hirakawa K. Cerebral blood flow: measurement with xenon-enhanced dynamic helical CT. Radiology. 1995;195(1):53\u201357."},{"issue":"2","key":"b36","series-title":"Neurosurgery","first-page":"327","article-title":"Predicting stroke risk in pediatric moyamoya disease with xenon-enhanced computed tomography","volume":"55","author":"McAuley DJ","year":"2004","unstructured":"McAuley DJ, Poskitt K, Steinbok P. Predicting stroke risk in pediatric moyamoya disease with xenon-enhanced computed tomography. Neurosurgery. 2004;55(2):327\u2013333."},{"issue":"3","key":"b37","series-title":"Eur J Radiol","first-page":"e557","article-title":"Arterial spin-labeling MR imaging in moyamoya disease compared with SPECT imaging","volume":"80","author":"Noguchi T","year":"2011","unstructured":"Noguchi T, Kawashima M, Irie H, Arterial spin-labeling MR imaging in moyamoya disease compared with SPECT imaging. Eur J Radiol. 2011;80(3):e557\u2013e562."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/139\/6\/article-p1697.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/139\/6\/article-p1697.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/139\/6\/article-p1697.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,18]],"date-time":"2024-05-18T06:44:45Z","timestamp":1716014685000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/139\/6\/article-p1697.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,1]]},"references-count":37,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2023.4.jns23294","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,1]]}}}