CJC Pediatric and Congenital Heart Disease最新文献

{"title":"Information for Readers","authors":"","doi":"10.1016/S2772-8129(25)00154-X","DOIUrl":"10.1016/S2772-8129(25)00154-X","url":null,"abstract":"","PeriodicalId":100249,"journal":{"name":"CJC Pediatric and Congenital Heart Disease","volume":"4 6","pages":"Page A1"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145749980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of the COVID-19 Pandemic on the Epidemiology of Kawasaki Disease in Canada","authors":"Nina Butris MSc ,&nbsp;Dominic Gangemi BSc ,&nbsp;Pedrom Farid BMSc ,&nbsp;Sunita O’Shea MA ,&nbsp;Tanveer Collins MD ,&nbsp;Nita Chahal NP, PhD ,&nbsp;Rayan Rahman BSc ,&nbsp;Vitor Guerra MD ,&nbsp;Brian W. McCrindle MD, MSc ,&nbsp;Cedric Manlhiot PhD","doi":"10.1016/j.cjcpc.2025.07.001","DOIUrl":"10.1016/j.cjcpc.2025.07.001","url":null,"abstract":"<div><h3>Background</h3><div>COVID-19 substantially changed the epidemiology of Kawasaki disease (KD), with decreased incidence reported globally. We sought to determine its effect in Canada.</div></div><div><h3>Methods</h3><div>Pediatric admissions for KD (2004-2023) were identified through the Canadian Institute for Health Information. Clinical data for KD hospitalizations at the Hospital for Sick Children in Toronto (2016-June 2023) were manually reviewed.</div></div><div><h3>Results</h3><div>The incidence of KD was stable before the pandemic (22.5 cases/100,000 children aged 0-4 years/year, <em>P</em> = 0.19). There was a 30% reduction across all regions during the early pandemic period (2020-2021) (15.8 cases/100,000 children aged 0-4 years), with blunting of traditional winter peaks. In the summer of 2022, an atypical peak in the incidence of KD was observed, aligning with the Delta wave. Epidemiology returned to normal patterns in 2023-2024 (+7% vs prepandemic to 24.1 cases/100,000 children aged 0-4 years), with notable differences in Ontario and the Prairies. Patients diagnosed during the early pandemic were more likely to present with incomplete KD (odds ratio [OR] [95% confidence interval (CI)]: 4.84 [3.22-7.30], <em>P</em> = 0.008), respiratory symptoms (OR [95% CI]: 2.59 [1.70-7.30], <em>P</em> = 0.03), or abdominal symptoms (OR [95% CI]: 4.84 [3.15-7.44], <em>P</em> &lt; 0.001). Those diagnosed in the late pandemic also presented with more incomplete KD (OR [95% CI]: 1.76 [1.16-2.66], <em>P</em> &lt; 0.001), respiratory symptoms (OR [95% CI]: 1.70 [1.05-2.75], <em>P</em> &lt; 0.001), or abdominal symptoms (OR [95% CI]: 2.53 [1.73-3.70], <em>P</em> &lt; 0.001), albeit to a lesser extent, along with a shorter duration of fever before diagnosis (parameter estimate [95% CI]: −0.82 [−1.52; −0.12] days, <em>P</em> = 0.02) and higher odds of developing KD shock syndrome (OR [95% CI]: 4.66 [1.83-11.87], <em>P</em> = 0.001). Throughout the pandemic, odds of developing giant coronary aneurysms or admission to the intensive care unit remained similar.</div></div><div><h3>Conclusions</h3><div>The pandemic saw a substantial decrease in the incidence of KD with disrupted seasonality. Prepandemic epidemiologic patterns have returned. Patient presentations changed, but outcomes remained stable compared with the prepandemic period.</div></div>","PeriodicalId":100249,"journal":{"name":"CJC Pediatric and Congenital Heart Disease","volume":"4 6","pages":"Pages 347-352"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145750139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual Peer Mentoring for Adolescents With Congenital Heart Disease: A Mixed-Methods Study of the iPeer2Peer Program in the Transition to Adult Care","authors":"Tieghan Killackey RN, PhD ,&nbsp;Sofia Olaizola BA ,&nbsp;Fareha Nishat MPH ,&nbsp;Richard Xi BSc ,&nbsp;Navreet Gill RN, MN ,&nbsp;Sandra Aiello RN ,&nbsp;Rafael Alonso-Gonzalez MD, MSc, FESC ,&nbsp;Conall Morgan MB, BCh, BaOFRCPC ,&nbsp;Jennifer Graham BSc ,&nbsp;Laura Veloso BSW, RPN ,&nbsp;Cindy Desbiens ,&nbsp;Charolette Desbiens ,&nbsp;Jennifer N. Stinson RN, PhD ,&nbsp;Sara Ahola Kohut PhD, CPsych","doi":"10.1016/j.cjcpc.2025.04.003","DOIUrl":"10.1016/j.cjcpc.2025.04.003","url":null,"abstract":"<div><h3>Background</h3><div>Adolescents with congenital heart disease (AWCHD) experience various symptoms, which can restrict social interactions and negatively impact quality of life. iPeer2Peer is an evidence-based virtual peer mentorship program that has improved outcomes for youth in several chronic illness populations. This study sought to examine the feasibility and acceptability of delivering the iPeer2Peer program to AWCHD.</div></div><div><h3>Methods</h3><div>A convergent, parallel mixed methods pre-post study design was used. AWCHD (13-18 years old) were recruited and matched with trained peer mentors (18-25 years old). Matched dyads completed up to 10 video calls over 15 weeks. Primary outcomes focused on engagement and acceptability (ie, accrual, withdrawal, number of calls, and qualitative feedback). Secondary outcomes focused on estimates of program effectiveness for this population (ie, transition readiness, quality of life, and self-efficacy).</div></div><div><h3>Results</h3><div>Study results demonstrated a participant accrual rate of 25% (19 of 76) and an enrollment rate of 95% (18 of 19). Eighteen adolescents (mean age 16.5 years, 50% female) were enrolled with a range of CHD diagnoses. A total of 16 mentees completed the program, with 2 lost to follow-up. Adherence to the study protocol was strong, with 74% of mentees completing study measures at the end of the program (T2) and at 6 months after the program (T3). The average number of calls per pair was 7.25, and the average call length was 40.25 minutes. Transition readiness and self-management increased across program time points (with statistically significant improvement from baseline to 6-month follow-up) and aligned with qualitative results that illustrated the benefits of social support in the transition to adult care.</div></div><div><h3>Conclusions</h3><div>This study demonstrated that the iPeer2Peer program was acceptable in this population. AWCHD were highly engaged and described the benefits of peer support during the transition process. Clinical programs may consider implementing similarly structured peer mentorship initiatives as a unique form of psychosocial support during the transition adult care.</div></div>","PeriodicalId":100249,"journal":{"name":"CJC Pediatric and Congenital Heart Disease","volume":"4 6","pages":"Pages 295-305"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145750230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proof-of-Concept of Online-Only Enrollment for Collecting Longitudinal Patient-Reported Outcomes in Young Individuals With Congenital Heart Disease","authors":"Laurence Watelle MD,&nbsp;Virginie Carrier MSc,&nbsp;Louis-Olivier Roy MSc,&nbsp;Marc-Olivier Pouliot,&nbsp;Frédéric Dallaire MD, PhD,&nbsp;Canadian Congenital and Pediatric Research Network","doi":"10.1016/j.cjcpc.2025.04.008","DOIUrl":"10.1016/j.cjcpc.2025.04.008","url":null,"abstract":"<div><h3>Background</h3><div>The importance of patient-reported outcomes (PRO) in research in congenital heart disease (CHD) is being increasingly recognized. The resources needed for direct, in-clinic enrollment of study participants are important barriers. Social media enable new ways to interact with potential participants. We aimed to test the feasibility of collecting PRO without direct contact by the research team, with subsequent linkage with the Quebec CHD Registry.</div></div><div><h3>Methods</h3><div>We targeted all patients with CHD aged ≥14 years and parent of a child with CHD aged 5-17 years who received cardiac care in Québec. We disseminated a link to an online survey consisting of 4 PRO instruments on the internet and by displaying in pediatric cardiology waiting rooms. No direct contact by a study team was done. The data were subsequently linked to a clinical registry of &gt;50,000 patients.</div></div><div><h3>Results</h3><div>A total of 160 people accessed the study, of whom 68 signed the consent form. A plateau of enrollment was quickly reached despite reminders. A total of 44 participants provided information for linkage to the clinical registry. The study had an over-representation of severe disease cases and lacked ethnic diversity. The retention rate at 1 year was 25%. Health-related quality of life was consistent with other CHD cohorts, and participants reported good satisfaction with life.</div></div><div><h3>Conclusion</h3><div>Recruiting participants with CHD without direct contact was ineffective at population level. Several factors may explain these results, including a weaker community network among participants than anticipated, apprehension about sharing personal information online, and difficulty effectively targeting participants on the internet.</div></div>","PeriodicalId":100249,"journal":{"name":"CJC Pediatric and Congenital Heart Disease","volume":"4 6","pages":"Pages 306-314"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145750231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unique Left Ventricular Outflow Tract Tunnel Lesion With a Subaortic Membranous Pouch: A Case Report","authors":"Nicolas Mourad BSc ,&nbsp;Wisam Abozaid MD ,&nbsp;Rebecca Liu BSc ,&nbsp;Kathryn R. Armstrong MD ,&nbsp;Ahamad Muhieldin MD","doi":"10.1016/j.cjcpc.2025.05.002","DOIUrl":"10.1016/j.cjcpc.2025.05.002","url":null,"abstract":"","PeriodicalId":100249,"journal":{"name":"CJC Pediatric and Congenital Heart Disease","volume":"4 6","pages":"Pages 343-346"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145750138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortoenteric Fistula Thirty-Seven Years After Repair for Midaortic Syndrome","authors":"Ali Fatehi Hassanabad MD, MSc ,&nbsp;Toshiro Sembo MD ,&nbsp;Kenton L. Rommens MD ,&nbsp;Holly Smith MD, MBA","doi":"10.1016/j.cjcpc.2025.04.007","DOIUrl":"10.1016/j.cjcpc.2025.04.007","url":null,"abstract":"","PeriodicalId":100249,"journal":{"name":"CJC Pediatric and Congenital Heart Disease","volume":"4 6","pages":"Pages 339-342"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145750137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Survivorship Bias in Neurocognitive Outcomes After Early Complex Cardiac Surgery Using Clustering and Propensity Scores","authors":"Morteza Hajihosseini PhD ,&nbsp;Sara Amiri MSc ,&nbsp;Charlene Robertson MD ,&nbsp;Ari R. Joffe MD, FRCPC ,&nbsp;Joseph Atallah MD, FRCPC ,&nbsp;Gonzalo Garcia Guerra MD, FRCPC ,&nbsp;Gwen Bond RN, MN ,&nbsp;Irina Dinu PhD ,&nbsp;Complex Pediatric Therapies Follow-up Program","doi":"10.1016/j.cjcpc.2025.05.005","DOIUrl":"10.1016/j.cjcpc.2025.05.005","url":null,"abstract":"<div><h3>Background</h3><div>Although advances in cardiac surgery have increased survival rates from congenital heart disease, neurocognitive and functional outcomes have not significantly improved. We hypothesized that the absence of change in outcome scores may be due to survivorship bias. Our study aimed to address this by adjusting neurocognitive and functional outcome trend lines using k-mean clustering and propensity score (PS) methods.</div></div><div><h3>Methods</h3><div>Prospective follow-up was conducted on 266 children with single ventricle congenital heart disease who underwent the Norwood procedure at age ≤6 weeks at Stollery Children's Hospital, Edmonton, Alberta, between 1997 and 2016. PS and k-mean clustering methods were used to adjust outcomes for children with more complex conditions. Crude and adjusted trend lines for neurocognitive and functional outcomes were analyzed using multiple linear regression models.</div></div><div><h3>Results</h3><div>Multiple logistic regression determined age at surgery, total ventilation days, deep hypothermic circulatory arrest time, and total days chest open were significant in PS calculation. The adjusted linear time-trend analysis of neurocognitive and functional outcomes showed no change in Full Scale Intelligence Quotient and Visual Motor Integration scores. Although not robust to using the different PS adjustment methods, General Adaptive Composite scores may have decreased over time. Models with PS adjustment were not different from models without PS adjustment.</div></div><div><h3>Conclusions</h3><div>PS adjustment with clustering did not confirm survivorship bias. PS-adjusted models demonstrated stable Full Scale Intelligence Quotient and Visual Motor Integration scores over time, and inconsistent findings for General Adaptive Composite scores. Improved survival after more complex cardiac surgery was not associated with worse long-term neurocognitive outcomes.</div></div>","PeriodicalId":100249,"journal":{"name":"CJC Pediatric and Congenital Heart Disease","volume":"4 6","pages":"Pages 315-329"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145750232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kawasaki Disease in Canada: The Impact of the COVID-19 Pandemic","authors":"Shannon Oliver MBBS,&nbsp;Michael Khoury MD, FRCPC","doi":"10.1016/j.cjcpc.2025.08.001","DOIUrl":"10.1016/j.cjcpc.2025.08.001","url":null,"abstract":"","PeriodicalId":100249,"journal":{"name":"CJC Pediatric and Congenital Heart Disease","volume":"4 6","pages":"Pages 353-355"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145749979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Impact of Partial Anomalous Pulmonary Venous Connection in Turner Syndrome","authors":"Estelle Tenisch MD ,&nbsp;Silvia Gigliotti MD ,&nbsp;Jenny Lam MD ,&nbsp;Kanetee Busiah MD ,&nbsp;Peter Kopp MD ,&nbsp;Florence Niel-Bütschi MD ,&nbsp;Nelly Pitteloud MD ,&nbsp;Judith Bouchardy MD ,&nbsp;Nicole Sekarski MD ,&nbsp;Magalie Ladouceur MD ,&nbsp;Tobias Rutz MD","doi":"10.1016/j.cjcpc.2025.06.004","DOIUrl":"10.1016/j.cjcpc.2025.06.004","url":null,"abstract":"<div><h3>Background</h3><div>Patients with Turner syndrome (TS) have a higher mortality than age-matched females, mainly due to cardiovascular disorders. Recently, an increased prevalence of partial anomalous pulmonary venous connection (PAPVC) was described in patients with TS. However, data on the clinical impact of PAPVC, that is, the need for surgical correction, are scarce. This study aimed at evaluating the prevalence and impact of congenital heart disease (CHD) with a focus on PAPVC in a TS population.</div></div><div><h3>Methods</h3><div>Patients with TS of all ages were included. Clinical data and reports of echocardiography, cardiac magnetic resonance (CMR), or computed tomography (CT) were retrospectively evaluated. CMR and CT were reviewed for PAPVC.</div></div><div><h3>Results</h3><div>Seventy-nine patients with TS were included (53 adults, 26 children [mean age 25 years, range 5-67 years]). Sixty-five patients underwent echocardiography, 41 CMR, and 3 CT. Cardiovascular disorders were present in 45% of patients and more frequently in karyotype monosomy X (76%), followed by 45, X mosaicism (39%), X structural rearrangements (18%), and other, unknown (16%) (<em>P</em> &lt; 0.02). The encountered CHD lesions were bicuspid aortic valve (N = 16, 24%), PAPVC (N = 6, 8%), and aortic coarctation (N = 4, 6%). Nine (13.4%) patients underwent surgery, mainly for aortic coarctation repair (N = 4). Only 1 of the 6 patients with PAPVC needed surgery.</div></div><div><h3>Conclusions</h3><div>The spectrum of cardiovascular disorders in TS appears to be associated with the karyotype. Among CHD lesions, bicuspid aortic valve is the most prevalent, followed by PAPVC, although the latter seems to have a minor impact on outcome. However, PAPVC is systematically missed on echocardiography and classically found in patients with complete monosomy X.</div></div>","PeriodicalId":100249,"journal":{"name":"CJC Pediatric and Congenital Heart Disease","volume":"4 6","pages":"Pages 330-337"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145750135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implantable Cardioverter-Defibrillator Therapy in Patients With Transposition of the Great Arteries: A Systematic Review of the Literature","authors":"Jessica Victoria Yao BBMed, MD, FRACP ,&nbsp;Ximena Cid-Serra MD, FRACP, PhD ,&nbsp;Karrar Albadosh MD, FABHS, FGHA ,&nbsp;Andrew Browne PhD ,&nbsp;Anastasia D. Egorova MD, PhD ,&nbsp;Magalie Ladouceur MD, PhD ,&nbsp;Craig Broberg MD ,&nbsp;Muhammad A. Nizam MD ,&nbsp;Paul Khairy MD, PhD, MHI ,&nbsp;Gareth J. Padfield BMSc, MBChB, PhD, MRCP ,&nbsp;Jeremy P. Moore MD ,&nbsp;Geetha Kandavello MBBS, MRCP ,&nbsp;Sushma Reddy MD ,&nbsp;Gruschen Veldtman MD ,&nbsp;Dominica Zentner MBBS, FRACP, PhD","doi":"10.1016/j.cjcpc.2025.04.006","DOIUrl":"10.1016/j.cjcpc.2025.04.006","url":null,"abstract":"<div><h3>Background</h3><div>Patients with a systemic right ventricle (sRV) due to transposition of the great arteries are known to have a particularly high risk of sudden cardiac death. Current guidelines issue a weak recommendation to consider primary prevention implantable cardioverter-defibrillator (ICD) implantation in patients with severe sRV dysfunction. This systematic review aims to ascertain factors that are associated with appropriate ICD therapy in patients with an sRV and primary prevention ICD, so that we can further refine selection criteria for implantation in this population.</div></div><div><h3>Methods</h3><div>A systematic search of MEDLINE and Embase was performed to identify all studies that explored ICD therapies and associated clinical characteristics in patients with an sRV and primary prevention ICD from the inception of the databases until February 14, 2023.</div></div><div><h3>Results</h3><div>A total of 11 articles were included in the final analysis. Among those with a primary prevention ICD, 23 (9.1%) had appropriate ICD therapies and 48 (19%) received inappropriate ICD therapies. Among those with appropriate ICD therapies, the most common reason for implantation was sRV dysfunction, followed by nonsustained ventricular tachycardia and ventricular tachycardia on a Holter monitor. Among those with a secondary prevention ICD, 15 (34.9%) received appropriate ICD therapies and 5 (11%) had inappropriate ICD therapies. Most inappropriate therapies were due to atrial tachyarrhythmias.</div></div><div><h3>Conclusions</h3><div>sRV dysfunction was the most consistently reported risk factor for appropriate ICD therapy in our review. Effective treatment of atrial tachyarrhythmias remains a priority. Larger scale studies are required to develop and validate risk calculation in this population.</div></div>","PeriodicalId":100249,"journal":{"name":"CJC Pediatric and Congenital Heart Disease","volume":"4 5","pages":"Pages 249-259"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}