International heart journal最新文献

{"title":"Does Respiratory Sinus Arrhythmia Increase Nocturnal Blood Pressure?","authors":"Miho Kuramoto, Masami Aizawa, Yuki Kuramoto, Masaaki Okabe, Yasushi Sakata, Yoshifusa Aizawa","doi":"10.1536/ihj.24-247","DOIUrl":"10.1536/ihj.24-247","url":null,"abstract":"<p><p>By ambulatory blood pressure monitoring (ABPM), nocturnal blood pressure (BP) may increase before heart rate (HR), but the details are unknown.Among 102 participants who underwent ABPM, > 90% on hypertension treatment, the averaged BP (HR) data were examined for the time at which the BP (HR) increased significantly above the mean midnight BP (HR) between 3:00 AM - 9:00 AM in all patients and in subgroups divided by clinical variables. Participants were also divided according to the respiratory sinus arrhythmia (RSA) index, which is the ratio of the longest and shortest RR intervals obtained under normal breathing, and the effects of RSA on the nocturnal hemodynamics were examined.The average age of the patients was 70 ± 11 years, and there were 47 (46.1%) males. After midnight, the BP increased and was significantly greater than the midnight BP at 5:00 AM. The time of significant increase in BP was affected by clinical variables and the RSA index; an RSA index < 5% (> 10%) was associated with the earliest (latest) time of BP increase. However, the HR remained unchanged until 7:00 AM or later. According to the ABPM data, a discordant time course between BP and HR and the effect of RSA were evident during the nocturnal period.BP increased earlier than HR toward dawn, and this phenomenon was affected by clinical variables. A low RSA index facilitated the onset of BP increase. The underlying mechanisms and clinical significance of the role of RSA in circulatory regulation remain to be investigated.</p>","PeriodicalId":13711,"journal":{"name":"International heart journal","volume":" ","pages":"81-87"},"PeriodicalIF":1.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-Specific Changes in Physical Function in Patients with Acute Decompensated Heart Failure.","authors":"Yuta Nakaya, Masanori Akamatsu, Kaho Yakushiji, Akiyoshi Ogimoto, Hiroaki Kitaoka","doi":"10.1536/ihj.24-168","DOIUrl":"10.1536/ihj.24-168","url":null,"abstract":"<p><p>Cardiac rehabilitation (CR) improves physical function in patients with acute decompensated heart failure (ADHF) and frailty. However, few studies have assessed physical function through multiple measures during hospitalization; moreover, the effect of age remains unclear. This study aimed to evaluate age-specific changes in physical function during the acute-phase treatment period in patients with ADHF. Patients with ADHF hospitalized between June 2018 and June 2023, who were aged ≥ 60 years and underwent CR, were included in the study. Physical function assessments at admission and discharge included grip strength, quadriceps isometric strength, short physical performance battery (SPPB), gait speed, and frailty. Changes in physical function from admission to discharge were assessed. The mean age of the 531 patients was 79.8 ± 9.0 years and 58% were male. Physical function at admission and discharge significantly decreased with age according to all measures. In patients aged ≥ 90 years, quadriceps isometric strength (0.27 ± 0.11 kgf/BW kg) and the SPPB score (4.5 ± 3.6 points) were severely impaired at admission. However, no significant differences were observed in changes in physical function according to age; the improvement in the SPPB score tended to increase with age (+1.7 ± 1.9, +2.3 ± 2.1, +2.2 ± 2.4, and +2.3 ± 1.8, in the 60-69-, 70-79-, 80-89-, and ≥ 90-year age groups, respectively). The improvement in frailty was similar in all groups. Although physical function declined with age, the changes in physical function were similar in patients with ADHF at any age above 60 years who underwent CR.</p>","PeriodicalId":13711,"journal":{"name":"International heart journal","volume":" ","pages":"66-73"},"PeriodicalIF":1.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esaxerenone Attenuates Cardiac Hypertrophy in a Pressure Overload Model in Mice.","authors":"Ou Hayashi, Yasuhiro Izumiya, Hiroya Hayashi, Hirotoshi Ishikawa, Daiju Fukuda","doi":"10.1536/ihj.24-169","DOIUrl":"10.1536/ihj.24-169","url":null,"abstract":"<p><p>Esaxerenone, a non-steroidal mineralocorticoid receptor (MR) blocker, exhibits high selectivity for MR. While clinically used as an anti-hypertensive drug, its impact on cardiac remodeling remains poorly understood. This study investigated the effect of esaxerenone on pressure overload-induced cardiac hypertrophy in mice.Eight-week-old C57BL/6 mice underwent either transverse aortic constriction (TAC) or sham surgery. Animals were divided into 2 groups: 0.003% (3.0 mg/kg) Esaxerenone-fed (EX) and normal-fed (CNT) groups (n = 64, Sham/CNT = 12, Sham/EX = 13, TAC/CNT = 18, TAC/EX = 21). Cardiac gene expressions were analyzed using quantitative real-time PCR.Food intake and body weight variations showed no significant differences between CNT and EX groups during the 2-week experimental period. The mortality rate from 24 hours after TAC surgery to the end of the experiment was 30.8% in the CNT group, however, all mice survived following TAC surgery in EX group. CNT group showed a remarkable increase in heart weight/tibial length ratio 2 weeks after TAC compared with the Sham group. The EX group demonstrated a significant decrease in HW/TL following TAC surgery (-23.4%, P = 0.041). Masson's trichrome staining revealed that the TAC/CNT group had a significantly higher proportion of fibrotic area than the Sham/CNT group. However, the TAC/EX group had a slightly lower proportion of fibrotic area than the TAC/CNT group. In cardiac gene expression analysis, ANP and Collagen 3a1 were upregulated in the TAC group but were significantly reduced following treatment with esaxerenone.Esaxerenone attenuates cardiac hypertrophy and hypertrophy-related gene expression, resulting in improved survival in a pressure overload model in mice.</p>","PeriodicalId":13711,"journal":{"name":"International heart journal","volume":"66 1","pages":"137-143"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventricular Tachycardia Ablation Using Map Merge Capable of Integrating Multiple Sessions.","authors":"Jun Yokota, Katsuhito Fujiu, Kent Doi, Norihiko Takeda","doi":"10.1536/ihj.24-685","DOIUrl":"10.1536/ihj.24-685","url":null,"abstract":"<p><p>This case report presents a novel approach for ventricular tachycardia (VT) ablation in a patient with cardiac sarcoidosis, utilizing the Map Merge function of the CARTO 3 system to integrate mapping data from multiple ablation sessions. A 62-year-old male with recurrent VT underwent initial endocardial ablation, where voltage mapping revealed no low-voltage areas (LVA) in the endocardium, though pace mapping matched clinical VT morphology. Fragmentation potentials were noted in the coronary vein, indicating a probable epicardial substrate. Ablation successfully suppressed VT, but recurrence occurred within 4 days, prompting a second, epicardial approach. During this session, voltage mapping identified broad LVAs with late potentials in the epicardium, aligning with prior endocardial sites. The Map Merge function enabled superimposing maps from both sessions, confirming spatial consistency between endocardial and epicardial LVAs and enhancing the precision of ablation targeting. Post-ablation, no VT recurrence was observed.This case underscores the clinical value of Map Merge, which improves procedural accuracy by integrating data across temporally distinct sessions, especially in VT cases involving epicardial substrates. By enabling comprehensive mapping without repeated epicardial mapping, Map Merge facilitates efficient identification and alignment of LVAs and abnormal potentials. This approach may improve outcomes in VT ablation by ensuring precise targeting, particularly in cases requiring endo-epicardial intervention.</p>","PeriodicalId":13711,"journal":{"name":"International heart journal","volume":"66 2","pages":"327-328"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Difference in Strategy and Clinical Outcomes of Left Main Disease in Japan and Non-Japanese Countries.","authors":"Takayuki Warisawa, Christopher M Cook, Yousif Ahmad, James P Howard, Henry Seligman, Christopher Rajkumar, Shunichi Doi, Sonoka Yuasa, Akihiro Nakajima, Takumi Toya, Masafumi Nakayama, Yuetsu Kikuta, Yoshiaki Kawase, Hidetaka Nishina, Rasha Al-Lamee, Amir Lerman, Hitoshi Matsuo, Yoshihiro J Akashi, Javier Escaned, Justin E Davies","doi":"10.1536/ihj.24-375","DOIUrl":"10.1536/ihj.24-375","url":null,"abstract":"<p><p>Although state-of-the-art therapy for left main disease (LMD) has been demonstrated to improve overall cardiovascular outcomes, it remains unclear whether differences in strategy and outcomes for Japanese and non-Japanese patients can be observed in a contemporary treatment.In this international multicenter registry, we analyzed 314 patients who received state-of-the-art management for LMD, including physiology-guided revascularization, coronary interventions using the latest drug-eluting stents aided by intracoronary imaging, or surgical procedures employing internal thoracic artery grafts, in conjunction with guideline-directed medical therapy. The patient cohort was divided into Japanese (n = 122) and non-Japanese (n = 192) groups. The primary endpoint was major adverse cardiovascular events (MACE), defined as death, non-fatal myocardial infarction, and ischemia-driven target lesion revascularization. Propensity score matching was utilized to account for baseline clinical variables.Baseline and lesion characteristics differed among groups, demonstrating higher frequency of diabetes and chronic kidney disease, higher SYNTAX score, and more severe stenosis in the Japanese cohort, resulting in a higher rate of revascularization performed (P < 0.05 for all). Percutaneous coronary intervention was significantly more frequently selected as the revascularization option (P < 0.001). While there were no significant differences in MACE between the 2 groups before adjustment, following adjustment, the Japanese cohort demonstrated significantly lower MACE at 4 years (6.3% versus 16.7%; HR: 0.37; 95%CI: 0.14-0.97; P = 0.042). Multivariate analysis further confirmed an independent association between Japanese patients and a reduced 4-year MACE risk (HR: 0.37; 95%CI: 0.14-0.96; P = 0.040).In a contemporary study with state-of-the-art therapy for LMD, patients who underwent treatment in Japan demonstrated better cardiovascular outcomes.</p>","PeriodicalId":13711,"journal":{"name":"International heart journal","volume":"66 2","pages":"202-212"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Arterial Stiffness on Cardiac Geometry.","authors":"Kazuhiro Shimizu, Ruiko Ohno, Masahiro Iwakawa, Shuji Sato, Yukihiro Morinaga, Naoaki Tanji, Tsuyoshi Tabata, Toshio Kinoshita","doi":"10.1536/ihj.24-727","DOIUrl":"10.1536/ihj.24-727","url":null,"abstract":"<p><p>Left ventricular hypertrophy (LVH), with the accompanying decrease in diastolic function, can originate from an augmented cardiac load caused by arterial stiffness (AS). The Cardio-Ankle Vascular Index (CAVI) is widely used as a good evaluation index for AS in Japan. We therefore conducted a longitudinal study aiming to determine the involvement of AS in changes in cardiac geometry using ultrasonography and CAVI.Between 2015 and 2020, 131 patients for whom echocardiography and CAVI measurements were performed at intervals of 401 ± 185 days were investigated to identify factors contributing to changes in cardiac geometry.Multivariate analysis showed that the value of change in the CAVI had an independent effect on the value of change in the left ventricular mass index (B = 4.023, β = 0.180, P = 0.046), which represents cardiac geometry, and on the value of change in relative wall thickness (RWT) (B = 0.021, β = 0.211, P = 0.010).This observational study suggested that improvements in CAVI, an indicator of cardiac afterload, may contribute to better cardiac remodeling, particularly in cases of concentric remodeling and concentric hypertrophy.</p>","PeriodicalId":13711,"journal":{"name":"International heart journal","volume":"66 3","pages":"449-455"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of Cholesterol Crystals Using the Filter Paper Rinse Method in Very Late Stent Thrombosis Cases.","authors":"Saki Mizobuchi, Keisuke Kojima, Yudai Tanaka, Yuta Hotsubo, Shohei Migita, Masatsugu Miyagawa, Katsunori Fukumoto, Yuki Nakajima, Yasunari Ebuchi, Riku Arai, Tomoyuki Morikawa, Takashi Mineki, Nobuhiro Murata, Daisuke Fukamachi, Yasuo Okumura","doi":"10.1536/ihj.24-450","DOIUrl":"10.1536/ihj.24-450","url":null,"abstract":"<p><p>Very late stent thrombosis (VLST) is a rare but critical complication of stent placement. In this report, we present 2 VLST cases diagnosed with neoatherosclerosis by detecting cholesterol crystals (CCs) via the filter paper rinse method. In terms of differentiating between neoatherosclerosis and stent thrombosis. There was no visible thrombus observed on thrombus aspiration. Examination of the blood sample obtained from the thrombus aspiration using the filter paper rinse method showed the presence of CCs under polarized light microscopy, thus, diagnosing VLST caused by neoatherosclerosis. Diagnosis of neoatherosclerosis would provide a rationale for intensive lipid-lowering therapy.</p>","PeriodicalId":13711,"journal":{"name":"International heart journal","volume":"66 1","pages":"175-178"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upstream Stimulatory Factor 2 Protects Cardiomyocytes by Regulating Mitochondrial Homeostasis.","authors":"Wenbin Wu, Kexin Zhao, Kejuan Li, Ziwei Zhu, Yongnan Li, Jianshu Chen, Hong Ding, Xiaowei Zhang","doi":"10.1536/ihj.23-619","DOIUrl":"10.1536/ihj.23-619","url":null,"abstract":"<p><p>Myocardial ischemia and hypoxia are the main causes of heart failure, and cardiomyocyte apoptosis induced by mitochondrial injury is the basis of adverse heart remodeling and heart failure. Upstream stimulatory factor 2 (USF2), a transcription factor involved in multiple cellular processes, was recently shown to play an active role in mitochondrial function and energy homeostasis. However, its involvement in cardiovascular disease has not been previously reported. In this study, we demonstrated that under hypoxic conditions, USF2 protein expression can be degraded via the ubiquitin-proteasome pathway in cardiomyocytes. The deletion of USF2 results in mitochondrial dysfunction and exacerbates mitochondrial damage, ultimately promoting apoptosis. Mechanistically, we demonstrated that USF2 deficiency induces apoptosis in cells by modulating the AMPK/mTOR signaling pathway. In conclusion, this study provides new insights into the protective role of USF2 in hypoxic cardiomyocyte injury and indicates that USF2 could be a potential therapeutic target for myocardial hypoxia.</p>","PeriodicalId":13711,"journal":{"name":"International heart journal","volume":"66 2","pages":"302-312"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous Pressure Cost for Cardiac Index Increases During Exercise in Patients with Fontan Circulation Versus Those with Biventricular Circulation.","authors":"Hiroyuki Takao, Koki Sugiyama, Takuro Kojima, Yoichi Iwamoto, Hirotaka Ishido, Satoshi Masutani","doi":"10.1536/ihj.24-490","DOIUrl":"10.1536/ihj.24-490","url":null,"abstract":"<p><p>Patients with Fontan circulation (Fontan) have a higher venous pressure (VP) and lower cardiac index (CI) than those with biventricular circulation (BiV). Although the cost to increase VP per unit CI (ΔVP/ΔCI) during exercise is expected to be higher in Fontan than in BiV, to our knowledge, no previous study has specifically tested ΔVP/ΔCI as the main variable.We included 9 patients with Fontan and 10 with postoperative BiV in this pilot study and assessed their hemodynamics via an ergometer-based exercise test. CI was continuously measured using impedance cardiography.The median age and quartile range values in patients with Fontan (15.0 [13.6, 16.7] years) were significantly higher than those in patients with BiV (12.9 [11.3, 14.3] years, P = 0.028). The ΔVP/ΔCI values were significantly higher in the Fontan group than in the BiV group at 25 W (4.5 [4.3, 6.0] versus 1.1 [0.9, 2.6] mmHg/ (L/minute/m²), respectively; P = 0.0008) and peak exercise (3.6 [33, 4.5] versus 1.1 [0.9, 1.5] mmHg/ (L/minute/m²), respectively; P = 0.0002) irrespective of age. The areas under the curve values of the 2 receiver operating curves (at 25 W and peak exercise time points) were 0.961 and 0.967, respectively. Patients with Fontan exhibited the 3 highest ΔVP/ΔCI values at peak exercise had an elevated New York Heart Association functional class (IIm-III) and hemodynamic concerns.Patients with Fontan displayed a higher cost to increase VP per unit CI. ΔVP/ΔCI may be a potential circulatory or prognostic marker for these patients and its value should be validated via larger prospective studies.</p>","PeriodicalId":13711,"journal":{"name":"International heart journal","volume":"66 2","pages":"271-278"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Significance of NT-proBNP in Patients with Low BNP Requiring Non-Surgical Intensive Care.","authors":"Riku Toguchi, Akihiro Shirakabe, Masato Matsushita, Shota Shighihara, Suguru Nishigoori, Tomofumi Sawatani, Kenichi Tani, Masaki Morooka, Shohei Kawakami, Yu Michiura, Nobuaki Kobayashi, Kuniya Asai","doi":"10.1536/ihj.24-702","DOIUrl":"https://doi.org/10.1536/ihj.24-702","url":null,"abstract":"<p><p>Serum N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and brain-type natriuretic peptide (BNP) levels are rarely evaluated simultaneously in patients requiring intensive care.A total of 4,724 patients were screened, and 1,755 patients with BNP levels < 100 pg/mL were analyzed. Patients were divided into two groups, according to the median value of the NT-proBNP/BNP ratio (low-NT-proBNP/BNP group [Group L] versus high-NT-proBNP/BNP group [Group H]). A multivariate logistic regression model showed that the C-reactive protein levels (per 1-mg/dL increase) and serum creatinine levels (per 1-mg/dL increase) were independently associated with a high NT-proBNP/BNP ratio (odds ratio: 1.251, 95% confidence interval [95% CI]: 1.172-1.335 and odds ratio: 1.941, 95% CI: 1.468-2.567, respectively). The Kaplan-Meier curve analysis showed that the prognosis was significantly poorer in Group H than in Group L. Moreover, a multivariate Cox regression model revealed that a high NT-proBNP/BNP ratio was an independent predictor of 365-day mortality (hazard ratio: 1.468, 95% CI: 1.027-2.067). The same significant trend in prognostic impact was observed in the low-creatinine (< 0.83 mg/dL, n = 883), high-creatinine (≥ 0.83 ng/dL, n = 872), and high- C-reactive protein (≥ 0.16 mg/dL, n = 842) cohorts.A high NT-proBNP/BNP ratio was associated with a non-cardiac condition. Consequently, it was independently associated with adverse outcomes in patients requiring intensive care, even in those with a low BNP value on admission.</p>","PeriodicalId":13711,"journal":{"name":"International heart journal","volume":"66 3","pages":"385-395"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}