{"title":"Effective Management of Cor Triatriatum Dexter Using Double Balloon Dilatation in a Paediatric Age Group Case-Report Study","authors":"","doi":"10.1016/j.cjcpc.2024.06.001","DOIUrl":"10.1016/j.cjcpc.2024.06.001","url":null,"abstract":"","PeriodicalId":100249,"journal":{"name":"CJC Pediatric and Congenital Heart Disease","volume":"3 4","pages":"Pages 137-140"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772812924000599/pdfft?md5=88b5260e75db582a0b79fa1d2314089e&pid=1-s2.0-S2772812924000599-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141402863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Radiation Reduction in Paediatric Cardiac Catheterization: We Can Go Even Lower","authors":"Talya Finke MBBS, BSc (Hons) , Gur Mainzer MD , Yonatan Yitzhak MRT , Sunder Devadas MRT , Dariusz Mroczek CVT, BioMed-Eng , Lee N. Benson MD, FRCPC, MSCAI , Sharon Borik MD","doi":"10.1016/j.cjcpc.2024.05.004","DOIUrl":"10.1016/j.cjcpc.2024.05.004","url":null,"abstract":"<div><h3>Background</h3><p>Radiation reduction is an integral component in the management of a paediatric cardiac catheterization laboratory. Simple and easily implementable protocol changes and technical upgrades have been shown to significantly reduce radiation exposure.</p></div><div><h3>Methods</h3><p>Radiation exposures (2020-2022) at Safra Children’s Hospital, Sheba Medical Center, Israel (unit A: n = 672) were retrospectively reviewed, including dose area product (DAP) (μGy m<sup>2</sup>), DAP/kg, Air Kerma (mGy), and fluoroscopy time (minutes) for 16 procedural types. Median doses were compared with those measured (2011-2014) at the Hospital for Sick Children, Toronto, Canada (unit B: n = 2033). Radiation reduction techniques included fluoroscopy acquisition at 7.5 frames/s, removal of antiscatter grids for children <30 kg, limiting field of view, use of Philips ClarityIQ technology, and an institutional culture of radiation mindedness.</p></div><div><h3>Results</h3><p>Exposure was significantly lower in unit A in 14 of 16 procedure types. Total median doses were lower in unit A (DAP: 91.4 [44.7-205.4] vs 387 [138.2-1339] μGy m<sup>2</sup> [<em>P</em> < 0.001], DAP/kg: 9.33 [4.3-16.4] vs 29.22 [12.8-65.9] μGy m<sup>2</sup>/kg [<em>P</em> < 0.001], and Air Kerma: 14.9 [7.8-29] vs 61 [23-176.4] mGy [<em>P</em> < 0.001]) despite higher fluoroscopy time (14.1 [4.2-24.6] vs 12.3 [6.8-23.3] minutes [<em>P</em> = 0.03]). DAP was lower for specific procedures including pulmonary valvuloplasty (46.3 [14.3-219.3] vs 127 [60-323] μGy m<sup>2</sup> [<em>P</em> < 0.001]) and patent ductus arteriosus closure (51.9 [18.8-111.8] vs 178 [96-410] μGy m<sup>2</sup> [<em>P</em> < 0.001]).</p></div><div><h3>Conclusions</h3><p>Enhanced radiation reduction techniques can lead to lower than previously published exposure levels across a wide range of procedure types when employing dose-limiting protocols and radiation reduction technology.</p></div>","PeriodicalId":100249,"journal":{"name":"CJC Pediatric and Congenital Heart Disease","volume":"3 4","pages":"Pages 129-136"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772812924000423/pdfft?md5=f403cdb9a3b0d4b0ed13b335a2620191&pid=1-s2.0-S2772812924000423-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142076708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sabrina H.Y. Eliason MD , Charlene M.T. Robertson MD , Susan A. Bobbitt MD , Sara Khademioureh MAct Sc , Irina A. Dinu PhD , Ari R. Joffe MD , Bryan V. Acton PhD
{"title":"Behaviour Concerns in Preschool Cardiac Surgery Survivors","authors":"Sabrina H.Y. Eliason MD , Charlene M.T. Robertson MD , Susan A. Bobbitt MD , Sara Khademioureh MAct Sc , Irina A. Dinu PhD , Ari R. Joffe MD , Bryan V. Acton PhD","doi":"10.1016/j.cjcpc.2024.04.001","DOIUrl":"10.1016/j.cjcpc.2024.04.001","url":null,"abstract":"<div><h3>Background</h3><p>Behaviour concerns (BC) are reported in survivors of complex cardiac surgery (CCSx) with inconsistent evidence about health and demographic variables that impact outcomes.</p></div><div><h3>Methods</h3><p>A prospective inception-cohort study of infants (without known chromosomal abnormalities) after CCSx from 2001 to 2017 determined Behaviour Assessment System for Children (BASC-II/III) parent rating scales at 4.5 years. <em>T</em> scores ≥60 for externalizing, internalizing, and the Behavioural Symptoms Index and ≤40 for adaptive behaviour defined BC. Potential predictive variables included demographic, acute care, and health factors after initial CCSx. Multiple logistic regression using the purposeful selection method gave odds ratios (ORs) with 95% confidence intervals (CIs).</p></div><div><h3>Results</h3><p>Survivors (n = 585; 61% boys, 40% single ventricle) were assessed at a median age of 55 months (interquartile range: 53, 57 months). Independent predictors were noncardiac hospitalizations (OR: 1.10, 95% CI: 1.02, 1.19; <em>P</em> = 0.015) for externalizing; noncardiac hospitalizations (OR: 1.14, 95% CI: 1.05, 1.24; <em>P</em> = 0.003), female sex (OR: 1.62, 95% CI: 1.04, 2.52; <em>P</em> = 0.031), and single ventricle (OR: 1.82, 95% CI: 1.04, 3.17; <em>P</em> = 0.035) for internalizing; noncardiac hospitalizations (OR: 1.10, 95% CI: 1.02, 1.19; <em>P</em> = 0.017), socioeconomic status (SES) (OR: 0.98, 95% CI: 0.96, 0.10; <em>P</em> = 0.031), and years of maternal schooling (OR: 0.91, 95% CI: 0.84, 0.10; <em>P</em> = 0.04) for adaptive; and extracorporeal life-saving support (OR: 2.03, 95% CI: 1.01, 3.96; <em>P</em> = 0.041) for the Behavioural Symptoms Index, indicating more pervasive behaviours.</p></div><div><h3>Conclusions</h3><p>The number of noncardiac hospitalizations predicted increased odds of BC and requires further attention. Improving inpatient trauma-informed care experiences and optimizing access to primary care to prevent noncardiac hospitalization may be modifiable.</p></div>","PeriodicalId":100249,"journal":{"name":"CJC Pediatric and Congenital Heart Disease","volume":"3 4","pages":"Pages 141-151"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772812924000381/pdfft?md5=0b3e1115d1c09283c8fecaa3dfd03aa8&pid=1-s2.0-S2772812924000381-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142076709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vicki St-Arnaud MSc , Ann Xiuli Chicoine BSc , Jean-Claude Tardif MD , David Busseuil PhD , Bianca D’Antono PhD
{"title":"Childhood Maltreatment and Body Mass Index in Older Adults With Chronic Illness","authors":"Vicki St-Arnaud MSc , Ann Xiuli Chicoine BSc , Jean-Claude Tardif MD , David Busseuil PhD , Bianca D’Antono PhD","doi":"10.1016/j.cjcpc.2024.03.002","DOIUrl":"10.1016/j.cjcpc.2024.03.002","url":null,"abstract":"<div><h3>Background</h3><p>Childhood trauma has been associated with greater psychological and physical morbidity, including a greater risk of developing coronary artery disease (CAD). Emotional dysregulation and increased body mass index (BMI) may be involved. This study evaluated whether (1) childhood maltreatment is associated with a higher BMI at study onset and with greater increases in BMI 5 years later among older adults with CAD or other chronic illnesses; (2) sex and/or CAD status moderate these results; and (3) baseline symptoms of anxiety, depression, and perceived stress (emotional dysregulation) mediate the association between childhood maltreatment and BMI at follow-up.</p></div><div><h3>Methods</h3><p>A total of 1232 men and women (aged 60.86 [6.95] years) completed validated questionnaires on childhood maltreatment and symptoms of psychological distress. The weight and height of the participant were measured, and the BMI was calculated using the weight (kg)/height (m<sup>2</sup>) ratio.</p></div><div><h3>Results</h3><p>Childhood maltreatment was not significantly associated with BMI at study onset nor at follow-up. This relation did not differ as a function of sex nor CAD status. Although childhood maltreatment was associated with significantly greater psychological distress at study onset (all <em>P</em> < 0.001), there latter was not found to mediate the relation between maltreatment and change in BMI at follow-up.</p></div><div><h3>Conclusions</h3><p>In contrast to previous literature, childhood maltreatment was not associated with BMI nor with the change in BMI over 5 years in men and women with chronic disease. However, as psychological distress increases risk for morbidity and mortality, it may represent an important target for prevention and intervention in survivors of childhood maltreatment.</p></div>","PeriodicalId":100249,"journal":{"name":"CJC Pediatric and Congenital Heart Disease","volume":"3 3","pages":"Pages 87-97"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S277281292400037X/pdfft?md5=8641f5ea353fcb65d3615aaa40356b5a&pid=1-s2.0-S277281292400037X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140781559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Ross Procedure in Children and Infants: A Systematic Review With Pooled Analyses","authors":"Nabil Dib MD, MSc , Walid Ben Ali MD, PhD , Thierry Ducruet MSc , Ofélie Trudeau MSc , Pierre-Luc Bernier MD , Nancy Poirier MD , Paul Khairy MD, PhD","doi":"10.1016/j.cjcpc.2024.02.004","DOIUrl":"10.1016/j.cjcpc.2024.02.004","url":null,"abstract":"<div><h3>Background</h3><p>The Ross procedure is a surgical option for congenital aortic stenosis that involves replacing the diseased aortic valve with a pulmonary autograft. Little is known about outcomes in children, particularly those younger than 1 year.</p></div><div><h3>Methods</h3><p>A systematic review with pooled analyses was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Inferred individual patient data were extracted from life tables. The primary end points were early (≤30 days) and late (>30 days) mortality rates following the Ross procedure in children. Secondary end points were freedom from reintervention for the right ventricular outflow tract and pulmonary autograft. These end points were assessed in the overall population of children. Sensitivity analyses were performed in subgroups younger than 1 year of age (infants) and in noninfant children.</p></div><div><h3>Results</h3><p>A total of 25 studies on 2737 patients met inclusion criteria. The pooled early survival rate was 96.0% (95% confidence interval [CI]: 95.1%-96.8%) overall and 86.8% (95% CI: 82.1%-90.3%) among infants. Pooled overall 10-year survival, freedom from pulmonary autograft reintervention, and freedom from right ventricular outflow tract reintervention rates were 91.1%, 90.2%, and 79.7%, respectively. Corresponding pooled rates in infants were 79.3%, 87.1%, and 51.2%. Mortality was significantly higher among infants compared with noninfant children (hazard ratio: 3.38, 95% CI: 2.44-4.68; <em>P</em> < 0.001). In metaregression analyses, younger age was strongly associated with poorer survival and higher reintervention rates.</p></div><div><h3>Conclusions</h3><p>Modest survival and autograft reoperation rates were observed following the Ross procedure in children. Surgery in infancy was strongly associated with poorer survival and higher reintervention rates.</p></div>","PeriodicalId":100249,"journal":{"name":"CJC Pediatric and Congenital Heart Disease","volume":"3 3","pages":"Pages 117-124"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772812924000228/pdfft?md5=c39d3a451aed5c004aa2f4517c6ce8ab&pid=1-s2.0-S2772812924000228-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140468316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicholas Grubic MSc , Jayati Khattar MPH , Vanessa De Rubeis PhD , Hailey R. Banack PhD , Julia Dabravolskaj PhD , Katerina Maximova PhD
{"title":"The Weight of Trauma: Navigating Collider Stratification Bias in the Association Between Childhood Maltreatment and Adult Body Mass Index","authors":"Nicholas Grubic MSc , Jayati Khattar MPH , Vanessa De Rubeis PhD , Hailey R. Banack PhD , Julia Dabravolskaj PhD , Katerina Maximova PhD","doi":"10.1016/j.cjcpc.2024.05.001","DOIUrl":"10.1016/j.cjcpc.2024.05.001","url":null,"abstract":"","PeriodicalId":100249,"journal":{"name":"CJC Pediatric and Congenital Heart Disease","volume":"3 3","pages":"Pages 98-101"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772812924000393/pdfft?md5=27f78b3793bcb3024e5e25af45761362&pid=1-s2.0-S2772812924000393-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141044997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joshua D. Griesman MBBCh, MSc, Audrey C. Marshall MD, MPH
{"title":"Headaches in Children After Transcatheter Device Closure of Atrial Septal Defects: A Single-Centre Experience","authors":"Joshua D. Griesman MBBCh, MSc, Audrey C. Marshall MD, MPH","doi":"10.1016/j.cjcpc.2024.01.001","DOIUrl":"10.1016/j.cjcpc.2024.01.001","url":null,"abstract":"<div><h3>Background</h3><p>Transcatheter device closure (TDC) is the most common treatment for isolated atrial septal defects in children. In the adult population, the incidence of new-onset migraine headache after TDC is well recognized and is estimated at 15%. New-onset headache after paediatric TDC has not been well described. We reviewed our centre’s experience to estimate the rate of headache complaints among paediatric patients after TDC.</p></div><div><h3>Methods</h3><p>We performed a single-centre, retrospective review of all children who underwent TDC between January 1, 2018, and December 31, 2021. For the included patients, we comprehensively reviewed the electronic medical record to identify patients reported to experience post-TDC headache.</p></div><div><h3>Results</h3><p>A total of 165 consecutive patients underwent TDC during the study period. Of these, 134 met inclusion criteria, and 20 patients (15%) had headache documented in the electronic medical record. Of 20 patients, 4 (20%) had headaches that led to further investigation or changed postprocedural medical management. Two patients had brain magnetic resonance imaging to investigate headaches; both studies were interpreted as nonpathologic. One patient required emergency department management for status migrainosus. A second, with a prior history of migraine, required admission for migraine exacerbation. In addition to those needing symptomatic management, 3 patients had a change in their antiplatelet regimen from aspirin to clopidogrel.</p></div><div><h3>Conclusions</h3><p>Our study suggests a minimal estimate of 15% as the incidence of headache in children who undergo TDC. This estimate can inform counselling before TDC. Determination of the true incidence will require focused prospective data collection.</p></div>","PeriodicalId":100249,"journal":{"name":"CJC Pediatric and Congenital Heart Disease","volume":"3 3","pages":"Pages 102-106"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772812924000022/pdfft?md5=b6c62dd1ba4ffb938ceba9b71f4ae4c1&pid=1-s2.0-S2772812924000022-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139639622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marwan H. Ahmed MBBS , William R. Miranda MD , Patrick S. Kamath MD , Moira H. Sugrue MD , C. Charles Jain MD , Maan Jokhadar MD , Luke J. Burchill MBBS, PhD , Heidi M. Connolly MD , Alexander C. Egbe MD, MPH, MS
{"title":"Outcomes of Esophageal Varices in Adults With Fontan Palliation and Liver Cirrhosis","authors":"Marwan H. Ahmed MBBS , William R. Miranda MD , Patrick S. Kamath MD , Moira H. Sugrue MD , C. Charles Jain MD , Maan Jokhadar MD , Luke J. Burchill MBBS, PhD , Heidi M. Connolly MD , Alexander C. Egbe MD, MPH, MS","doi":"10.1016/j.cjcpc.2024.01.002","DOIUrl":"10.1016/j.cjcpc.2024.01.002","url":null,"abstract":"<div><h3>Background</h3><p>The purpose of this study was to define the risk and outcomes of esophageal varices in adults with Fontan palliation and liver cirrhosis undergoing esophagogastroduodenoscopy (EGD).</p></div><div><h3>Method</h3><p>The results of EGD, abdominal ultrasound, and liver biopsy, as well as clinic notes from the hepatologist, were reviewed to determine the diagnosis of cirrhosis and esophageal varices. The incidence of acute gastrointestinal bleeding complication was assessed among patients with esophageal varices using the time of EGD as the baseline.</p></div><div><h3>Results</h3><p>Of 149 patients with Fontan palliation and liver cirrhosis, the prevalence of esophageal varices at baseline EGD was 34% (51 of 149). Of 98 patients without esophageal varices at baseline EGD, 27 (27%) underwent subsequent EGD, of whom 11 showed a new diagnosis of esophageal varices. The incidence of a new diagnosis of esophageal varices was 9% per year. Of 62 patients with esophageal varices, 9 (15%) had acute gastrointestinal bleeding complications during 45 (37-62) months of follow-up, yielding an incidence of 5% per year. Of the 9 patients, 8 underwent EGD and variceal banding during the hospitalization for bleeding and 1 patient died of septicaemia. Of the 8 patients who survived to hospital discharge, 2 patients were readmitted for esophageal bleeding within 12 months from the index hospitalization. Higher hepatic vein wedge pressure and hepatic vein pressure gradient were associated with esophageal varices and bleeding complications.</p></div><div><h3>Conclusions</h3><p>In this selected sample of adults with Fontan palliation and liver cirrhosis, esophageal varices were relatively common, and patients with esophageal varices had risk of bleeding complications.</p></div>","PeriodicalId":100249,"journal":{"name":"CJC Pediatric and Congenital Heart Disease","volume":"3 3","pages":"Pages 107-114"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772812924000186/pdfft?md5=a36a4d2e82ec1551f1693a20c1a0dc6a&pid=1-s2.0-S2772812924000186-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139830274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Snigdha Karnakoti MBBS, Kartik Andi MBBS, William R. Miranda MD, C. Charles Jain MD, Luke J. Burchill MBBS, PhD, Maan Jokhadar MD, Heidi M. Connolly MD, Alexander C. Egbe MD, MPH, MS
{"title":"Outcomes of Sodium-Glucose Cotransporter 2 Inhibitor Use in Adults With Congenital Heart Disease","authors":"Snigdha Karnakoti MBBS, Kartik Andi MBBS, William R. Miranda MD, C. Charles Jain MD, Luke J. Burchill MBBS, PhD, Maan Jokhadar MD, Heidi M. Connolly MD, Alexander C. Egbe MD, MPH, MS","doi":"10.1016/j.cjcpc.2024.02.001","DOIUrl":"https://doi.org/10.1016/j.cjcpc.2024.02.001","url":null,"abstract":"","PeriodicalId":100249,"journal":{"name":"CJC Pediatric and Congenital Heart Disease","volume":"3 3","pages":"Pages 115-116"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772812924000198/pdfft?md5=a7dc6c26b726b8cab7ca6f41e1e1f0cb&pid=1-s2.0-S2772812924000198-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141485058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}