Journal of Thrombosis and Haemostasis最新文献

{"title":"Beyond the platelet clot: β3 integrin-c-Src signaling at the crossroads of thrombosis and T-cell homeostasis","authors":"K. Vinod Vijayan, Jianlin Qiao","doi":"10.1016/j.jtha.2026.07.016","DOIUrl":"10.1016/j.jtha.2026.07.016","url":null,"abstract":"","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3461-3463"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suspicion-based screening for occult malignancy in lower-extremity venous thrombosis: a real-world cohort study","authors":"Yael Appelboom,&nbsp;Inge H.Y. Luu,&nbsp;Aukje Swillens,&nbsp;Eveline Bos,&nbsp;Kon-Siong G. Jie,&nbsp;Roel van Kampen,&nbsp;Math P.G. Leers,&nbsp;Guy J.M. Mostard,&nbsp;Daan J.L. van Twist","doi":"10.1016/j.jtha.2026.06.044","DOIUrl":"10.1016/j.jtha.2026.06.044","url":null,"abstract":"<div><h3>Background</h3><div>Malignancy screening after deep vein thrombosis (DVT) remains controversial. Extensive screening strategies have not demonstrated improved patient outcomes and may cause overdiagnosis. International guidelines recommend chest X-ray and sex-specific cancer screening, whereas Dutch and National Institute for Health and Care Excellence guidelines recommend a suspicion-based approach, with additional diagnostics only when clinical clues for malignancy are present. However, its effectiveness and safety in real-world practice remain uncertain.</div></div><div><h3>Objectives</h3><div>The aim of this study was to evaluate the real-world performance of suspicion-based screening for malignancy in a cohort of patients with lower extremity venous thrombosis.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed all patients with suspected DVT between 2016 and 2019. Based on ultrasound findings, patients were classified as having DVT, superficial vein thrombosis (SVT), or no thrombosis (controls). All patients underwent standardized history taking, physical examination, and limited laboratory testing. Additional diagnostics for malignancy were performed only when clinical suspicion existed. Long-term follow-up was the reference standard for malignancy diagnosis.</div></div><div><h3>Results</h3><div>A total of 1285 patients (258 DVT, 179 SVT, and 848 controls) were followed for a median of 5 years. First-year malignancy incidence was higher in patients with DVT (6.2%) than in SVT (2.2%) or controls (2.3%). Additional diagnostics were performed in 57.8% of patients with DVT, 18.4% of patients with SVT, and 9.2% of controls (<em>P</em> &lt; .001). Malignancies were detected in 4.6%, 1.1%, and 1.3% of these groups, respectively. Among patients without additional diagnostic testing, malignancy was diagnosed within 1 year in 0.8%, 1.1%, and 1.3% of these groups, respectively. The negative predictive value of suspicion-based screening was 98.2% in patients with DVT and 98.6% in both patients with SVT and controls.</div></div><div><h3>Conclusion</h3><div>In this real-world cohort, suspicion-based screening demonstrated a high negative predictive value with few missed malignancies, supporting a restrictive screening strategy in clinical practice.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3669-3678"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148422178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of intermediate- and high-risk pulmonary embolism—a case of a pregnant patient","authors":"Wilhelmina J.E. Stenger,&nbsp;Adriaan O. Kraaijeveld,&nbsp;Thijs E. van Mens,&nbsp;Marieke Sueters,&nbsp;Corstiaan A. den Uil,&nbsp;Frederikus A. Klok","doi":"10.1016/j.jtha.2026.06.026","DOIUrl":"10.1016/j.jtha.2026.06.026","url":null,"abstract":"<div><div>Acute pulmonary embolism (PE) has a heterogeneous clinical presentation, varying from mild chest symptoms to shock or cardiac arrest. Optimal management of severe acute PE requires assessment of multiple parameters to confirm the diagnosis and assess the patient’s prognosis, preferably by EXPERT-PE care/Pulmonary Embolism Response Teams (PERTs), integrating multidisciplinary expertise to optimize PE management. While management of severe acute PE already can be challenging, this particularly applies to certain patient subgroups, in particular pregnant women. As a result of ruling out pregnant women in randomized trials, specific guideline recommendations on severe PE are unavailable. This case-based narrative review aims to provide an overall overview of the approach to treating patients with severe PE, based on the comprehensive case description of a pregnant patient with high-risk PE.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3464-3473"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma levels of adiponectin and risk of future incident venous thromboembolism","authors":"Asbjørn L. Onsaker,&nbsp;Astrid van Hylckama Vlieg,&nbsp;Thor Ueland,&nbsp;Pål Aukrust,&nbsp;Sigrid K. Brækkan,&nbsp;John-Bjarne Hansen,&nbsp;Vânia M. Morelli","doi":"10.1016/j.jtha.2026.07.023","DOIUrl":"10.1016/j.jtha.2026.07.023","url":null,"abstract":"<div><h3>Background</h3><div>Adiponectin, a hormone-like protein primarily secreted by adipocytes, is typically decreased in obesity. Adiponectin has been shown to have antithrombotic properties through regulation of hemostatic factors <em>in vitro</em>. However, the association between adiponectin and venous thromboembolism (VTE) remains unclear.</div></div><div><h3>Objectives</h3><div>To investigate the association between plasma adiponectin levels and risk of future first lifetime VTE.</div></div><div><h3>Methods</h3><div>A population-based nested case-control study, including 381 VTE cases and 772 age-and sex-matched controls, was derived from the Tromsø4 survey (1994/95-2007). Adiponectin was measured in samples collected at cohort inclusion. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for VTE across adiponectin quartiles (Q) determined in controls using sex-specific quartile cut-offs. To investigate short-term associations, time-restricted analysis was performed including VTE cases occurring up to 5 years after cohort inclusion.</div></div><div><h3>Results</h3><div>High adiponectin levels were associated with decreased VTE risk, with an OR of 0.69 (95% CI 0.48-0.99) for Q4 vs Q1 (reference) in age- and sex-adjusted analysis for the entire study period. The inverse association between adiponectin and VTE risk was stronger with analysis restricted to the first 5 years after cohort inclusion, with an OR of 0.40 (95% CI 0.20-0.77) for Q4 vs Q1. The additional adjustment for body mass index and C-reactive protein had minor impact on risk estimates.</div></div><div><h3>Conclusion</h3><div>Our results suggest that high plasma adiponectin levels are associated with decreased risk of future first lifetime VTE, particularly shortly after cohort inclusion, and that adiponectin might play a role in the pathogenesis of VTE.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3702-3710"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disseminated intravascular coagulation in pregnancy: insights from an international collaborative registry","authors":"Jerome J. Federspiel,&nbsp;Callie Berkowitz,&nbsp;Grace Lim","doi":"10.1016/j.jtha.2026.07.025","DOIUrl":"10.1016/j.jtha.2026.07.025","url":null,"abstract":"","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3458-3460"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular endothelial growth factor inhibition and anticoagulation: focus on mucosal bleeding and platelet count","authors":"Aaron Leonid Sverdlov,&nbsp;Benjamin Reardon,&nbsp;Doan Minh Thi Ngo","doi":"10.1016/j.jtha.2026.06.040","DOIUrl":"10.1016/j.jtha.2026.06.040","url":null,"abstract":"","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3446-3449"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term real-world effectiveness and safety of edoxaban in chronic thromboembolic pulmonary hypertension: a nationwide registry study","authors":"Kazuya Hosokawa,&nbsp;Kohei Masaki,&nbsp;Masayuki Hirose,&nbsp;Takumi Inami,&nbsp;Yu Taniguchi,&nbsp;Shiro Adachi,&nbsp;Keimei Yoshida,&nbsp;Jun Yamashita,&nbsp;Nobuhiro Yaoita,&nbsp;Junichi Nakamura,&nbsp;Shun Minatsuki,&nbsp;Nobutaka Ikeda,&nbsp;Naohiro Komura,&nbsp;Yoshihiro Dohi,&nbsp;Nobuhiro Tanabe,&nbsp;Ayako Shigeta,&nbsp;Kayoko Kubota,&nbsp;Yoshito Ogihara,&nbsp;Koshin Horimoto,&nbsp;Hiroto Shimokawahara,&nbsp;Kohtaro Abe","doi":"10.1016/j.jtha.2026.06.012","DOIUrl":"10.1016/j.jtha.2026.06.012","url":null,"abstract":"<div><h3>Background</h3><div>Long-term real-world outcomes of edoxaban in chronic thromboembolic pulmonary hypertension (CTEPH) remain incompletely characterized despite emerging evidence, including the KABUKI randomized trial.</div></div><div><h3>Objectives</h3><div>To evaluate long-term effectiveness and safety of edoxaban in patients with CTEPH using a nationwide registry.</div></div><div><h3>Methods</h3><div>We analyzed the CTEPH AC Registry, a multicenter prospective observational cohort. Patients with CTEPH receiving edoxaban at registration were included. The primary effectiveness endpoint was morbidity and mortality events, a composite of all-cause death, lung transplantation, rescue pulmonary endarterectomy or balloon pulmonary angioplasty, ≥15% decline in 6-minute walk distance with worsening World Health Organization functional class, or symptomatic venous thromboembolism. The primary safety endpoint was clinically relevant bleeding according to International Society on Thrombosis and Haemostasis criteria.</div></div><div><h3>Results</h3><div>Among 408 patients, median follow-up was 552 days. The cumulative incidence of morbidity and mortality events was 4.7%, 10.0%, and 14.1% at 1, 3, and 5 years, respectively. The cumulative incidence of clinically relevant bleeding was 3.2%, 4.8%, and 5.6%, respectively, and major bleeding occurred in 2.4% at 5 years. Symptomatic venous thromboembolism occurred in 1.5% at 5 years. Outcomes were broadly consistent across reperfusion history, World Health Organization functional class, edoxaban dose, and renal function strata.</div></div><div><h3>Conclusions</h3><div>In this Japanese nationwide registry, long-term edoxaban therapy was associated with sustained clinical stability in patients with CTEPH. No clear late-emerging safety signal was observed, but extrapolation beyond Japan requires caution, particularly in patients with different body size, renal function, or concomitant medication profiles.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3564-3577"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148277744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbon tetrachloride (CCl4)-induced liver injury activates hepatocyte-independent tissue factor-driven coagulation","authors":"Amish K. Patel,&nbsp;Gina E. Capece,&nbsp;Bianca Hazel,&nbsp;Tayana Roychowdhury,&nbsp;Noah A. Mac,&nbsp;Daniel Hu,&nbsp;Kevin S. Baker,&nbsp;Maria T. Fernandes-Fonseca,&nbsp;Zimu Wei,&nbsp;Ana T.A. Sachetto,&nbsp;Michael J. Goedken,&nbsp;James P. Luyendyk,&nbsp;Nigel Mackman,&nbsp;Lauren G. Poole","doi":"10.1016/j.jtha.2026.07.017","DOIUrl":"10.1016/j.jtha.2026.07.017","url":null,"abstract":"<div><h3>Background</h3><div>Liver injury is associated with activation of the blood coagulation cascade. Hepatocytes express low levels of tissue factor (TF), the transmembrane receptor and cofactor for coagulation factor VIIa (FVIIa). The TF-FVIIa complex activates the extrinsic coagulation pathway and plays an essential role in hemostasis.</div></div><div><h3>Objectives</h3><div>This study tested the hypothesis that hepatocyte TF drives coagulation activation after toxicant-induced liver injury.</div></div><div><h3>Methods</h3><div>Wild-type mice, mice with whole-body TF deficiency (LowTF), and mice lacking TF specifically in hepatocytes (HPC^ΔTF) were challenged once with carbon tetrachloride (CCl₄, 1 mL/kg, intraperitoneally). Liver injury and coagulation parameters were evaluated 2 to 96 hours after challenge. In separate studies, mice were challenged twice weekly for 4 to 6 weeks, and samples were collected 24 to 72 hours after the final challenge.</div></div><div><h3>Results</h3><div>Acute CCl₄ challenge caused hepatic injury and robust coagulation activation. Whole-body TF deficiency significantly reduced coagulation activation and attenuated peak hepatocellular necrosis, whereas hepatocyte TF deficiency had no effect on coagulation activation or acute liver injury. <em>In situ</em> hybridization identified cells in inflammatory foci expressing TF (<em>F3</em>) transcripts in the necrotic region of the CCl₄-challenged liver. After chronic CCl₄ challenge, whole-body TF deficiency significantly reduced coagulation activation and modestly decreased fibrosis by means of reduced hepatic stellate cell activation, but hepatocyte TF deficiency did not affect coagulation activation or liver fibrosis.</div></div><div><h3>Conclusion</h3><div>These data suggest that TF-expressing nonparenchymal cells mediate coagulation activation during CCl₄-induced liver injury. Our findings provide the foundation for future work to identify TF-expressing cell types and their underlying contributions to liver injury pathogenesis.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3687-3701"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a new disseminated intravascular coagulation score tailored for patients with chronic liver disease: a prospective observational study","authors":"Ecaterina Scarlatescu,&nbsp;Ton Lisman","doi":"10.1016/j.jtha.2026.05.024","DOIUrl":"10.1016/j.jtha.2026.05.024","url":null,"abstract":"<div><h3>Background</h3><div>Diagnosing disseminated intravascular coagulation (DIC) in patients with chronic liver disease is challenging because cirrhosis-related hemostatic abnormalities mimic DIC laboratory features, leading to frequent overdiagnosis using conventional DIC scoring systems.</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate the performance of existing DIC scores in patients with cirrhosis and develop a tailored diagnostic prediction tool.</div></div><div><h3>Methods</h3><div>We prospectively enrolled 80 consecutive patients with cirrhosis admitted to a single intensive care unit. Clinical manifestations of DIC, conventional DIC scores, routine hemostatic parameters, and advanced coagulation biomarkers were assessed. Machine learning techniques combining random forest, logistic regression, and extreme gradient boosting with the Synthetic Minority Oversampling Technique were used to develop a DIC prediction model using 4 routinely available parameters: chronic liver failure—sequential organ failure assessment score, platelet count, fibrinogen, and D-dimer levels.</div></div><div><h3>Results</h3><div>Conventional DIC scores (the International Society on Thrombosis and Haemostasis, the Japanese Association for Acute Medicine, and the Japanese Ministry of Health, Labour, and Welfare) were positive in &gt;50% of patients at study inclusion despite only 1.3% having clinical DIC manifestations, demonstrating substantial overdiagnosis. During follow-up, 10 patients (12.5%) developed clinical DIC with 90% mortality, while positive DIC scores did not predict outcomes. The newly developed ensemble prediction model achieved 100% sensitivity and 87% specificity, accurately discriminating clinical DIC from cirrhosis-related hemostatic abnormalities. Coagulation activation marker levels were elevated universally, while progressive fibrin monomer level depletion distinguished overt DIC from compensated hemostatic imbalance.</div></div><div><h3>Conclusion</h3><div>The proposed prediction tool showed excellent internal performance in identifying DIC risk in patients with cirrhosis using readily available parameters, and its implementation in a freely accessible web-based application may facilitate future clinical use after external validation.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3474-3488"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148150166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transfer of emicizumab into breast milk in postpartum acquired hemophilia A","authors":"Simon Alexander Krooss,&nbsp;Tim Halling,&nbsp;Dirk Varnholt,&nbsp;Annika Klingberg,&nbsp;Korbinian Brand,&nbsp;Sonja Werwitzke,&nbsp;Heiner Wedemeyer,&nbsp;Christiane Dobbelstein,&nbsp;Andreas Tiede,&nbsp;Olga Oleshko","doi":"10.1016/j.jtha.2026.07.001","DOIUrl":"10.1016/j.jtha.2026.07.001","url":null,"abstract":"<div><h3>Background</h3><div>Acquired hemophilia A (AHA) is a rare, potentially life-threatening autoimmune bleeding disorder caused by neutralizing autoantibodies against factor (F)VIII. The postpartum period is a recognized risk factor for AHA. Emicizumab is increasingly used for hemostatic prophylaxis in AHA, including in women who may wish to continue breastfeeding. However, data on transfer of emicizumab into breast milk are lacking. This limits evidence-based counseling and shared decision-making.</div></div><div><h3>Objective</h3><div>To assess whether emicizumab is detectable in the breast milk of a patient with postpartum AHA.</div></div><div><h3>Methods</h3><div>Plasma and breast milk samples were collected from a woman who developed AHA 4 months after delivery and was treated with emicizumab while breastfeeding. Samples were analyzed for emicizumab using a modified one-stage clot assay and for anti-FVIII immunoglobulin (Ig)G and IgA antibodies using immunoassays.</div></div><div><h3>Results</h3><div>Emicizumab was measurable in breast milk shortly after treatment initiation and reached concentrations of up to 20 μg/mL. The steady-state plasma concentration of emicizumab was 42 μg/mL. Anti-FVIII IgG and IgA were detected in plasma but not in breast milk samples.</div></div><div><h3>Conclusion</h3><div>In this patient with postpartum AHA, emicizumab was detectable in breast milk, whereas FVIII inhibitors were not. These findings are relevant for counseling breastfeeding women receiving emicizumab. Further studies are needed to determine the extent and clinical relevance of infant exposure.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3531-3537"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}