Pediatric Surgery International最新文献

{"title":"Enteric neural stem cell neurogenesis by glial cell-derived neurotrophic factor in experimental Hirschsprung's disease.","authors":"Amnuay Kleebayoon, Viroj Wiwanitkit","doi":"10.1007/s00383-024-05902-x","DOIUrl":"10.1007/s00383-024-05902-x","url":null,"abstract":"","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"40 1","pages":"313"},"PeriodicalIF":1.5,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synergistic use of Unplanned Reoperation and Hospital Readmission rates for quality monitoring in pediatric surgical care.","authors":"Galindo Margarita, Contreras Catalina, Benavente Ana, Cancino Bélgica, Montedonico Sandra","doi":"10.1007/s00383-024-05894-8","DOIUrl":"10.1007/s00383-024-05894-8","url":null,"abstract":"<p><strong>Introduction: </strong>Unplanned reoperation (URO) and unplanned hospital readmission (UHR) are key quality indicators used to assess healthcare quality improvement. The aim of this study was to describe, quantify, analyze and compare both indicators in a Pediatric Surgery Department.</p><p><strong>Methodology: </strong>An observational study was conducted reviewing the medical records of pediatric patients who underwent unplanned reoperation and unplanned hospital readmission over a six-year period in a pediatric surgical unit. The incidence, indications, and causes of reoperations and readmissions were analyzed.</p><p><strong>Results: </strong>A total of 6,376 surgeries were performed over a six-year period. During this time, there were 37 (0.58%) URO and 20 (0.31%) UHR. There were 23/2,437(0.94%) URO and 14/2,437(0.57%) UHR among emergency surgeries. In contrast, there were 14/3,939(0.35%) URO and 6/3,939(0.15%) UHR among elective surgeries (p < 0.05). Outpatient surgeries had 3/1,639 (0.18%) URO and 1/1,639 (0.06%) UHR compared to inpatient surgeries that had 11/2,300(0.47%) URO and 5/2,300 (0.21%) UHR respectively (p = ns). A total of 1,570 appendectomies were performed during the study period, with 8/1,570(0.5%) patients requiring either a URO or a UHR. The most frequent indication for both URO and UHR were intra-abdominal infections. The main cause of URO was a technical error during surgery (70%), while the main cause of UHR was an error in the medical treatment (35%).</p><p><strong>Conclusion: </strong>In our practice, URO are more frequent than UHR. Emergency surgeries have a higher risk of undergoing an URO or a UHR. Acute appendicitis is the most common diagnosis associated with the need for an URO or a UHR. The majority of unplanned reoperation cases are due to technical errors during surgery.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"40 1","pages":"312"},"PeriodicalIF":1.5,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-do hypospadias surgery following failed previous repair: lessons learned over two decades of experience.","authors":"May Fihman, Leon Chertin, Stanislav Kocherov, Jawdat Jaber, Boris Chertin, David Dothan","doi":"10.1007/s00383-024-05896-6","DOIUrl":"10.1007/s00383-024-05896-6","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate our experience with different surgical techniques and to find clinical factors that affect the outcome of treatment in cases of redo-hypospadias.</p><p><strong>Methods: </strong>We have retrospectively evaluated demographic and clinical data of children who underwent redo or cripple-hypospadias repair.</p><p><strong>Results: </strong>Between 2004 and 2021, 76 patients met the inclusion and exclusion criteria. The median age of the first cripple-hypospadias surgery was 64.8 ± 62.9 months. Upon primary surgery 5(6.6%) patients presented with distal-hypospadias, 13(17.1%) midshaft-hypospadias, 37(48.7%) proximal-hypospadias and 21(27.6%)with an unknown initial meatal status. To correct cripple-hypospadias 3(3.9%) patients underwent meatal-advancement and meatoplasty 32(42.1%) different tubularization techniques, 25(32.9%) required flap/graft, 13(17.1%) staged procedure and in 3(3.9%) surgical technique was undefined. Fifty-four (71%) children presented with post-surgery complications: 25(32.9%) meatal retraction, 19(25.3%) meatal stenosis and 17(22.3%) developed urethro-cutaneous fistula. Thirty-six (47.4%) patients underwent additional surgeries. There was no association between surgical technique or age and the need for additional surgeries (P = 0.831, P = 0.425 respectively). There was no association between surgical technique or age and surgical complications (P = 0.514, P = 0.425 respectively). All surgical techniques except meatal-advancement might lead to urethral stricture on long term follow-up (P = 0.028).</p><p><strong>Conclusions: </strong>Our data show that treatment of cripple-hypospadias is challenging for both surgeon and patients alike. There is a need to tailor a surgical technique to each patient and there is no one technique which is appropriate for all patients.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"40 1","pages":"311"},"PeriodicalIF":1.5,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-vascularisation of the acellular bladder matrix using the omentum in a porcine model prior for bladder reconstruction-a step towards clinical application?","authors":"J B David Keene, Raef Jackson, Gauri Batra, Domonkos Csukas, Gyorgyi Szabo, Vanda Molnar, Tamas Cserni","doi":"10.1007/s00383-024-05855-1","DOIUrl":"10.1007/s00383-024-05855-1","url":null,"abstract":"<p><strong>Aim: </strong>Research studies with porcine acellular bladder matrix (PABM) showed integration of only small sized stamps in recipient bladders, however for clinical use in bladder augmentation significantly larger patches are needed. We hypothesised pre-vascularisation with omentum may be a step towards clinical translation.</p><p><strong>Method: </strong>Eight domestic pigs were operated three times 8-10 weeks apart: 1-Implantation; PABM with recorded dimensions were sutured around a tissue expanding device, wrapped in omentum and sutured to the anterior abdominal wall. 2-Augmentation; hemi-cystectomy and bladder augmentation was performed with the pre-vascularized PABM using non-absorbable suture 3-Sacrifice; The dimensions of the PABMs were measured macroscopically, the in-vivo microcirculation of the PABMs were assessed using laser speckle contrast imaging. HE staining, uroplakin 3 and CK7 immunohistochemistry was performed.</p><p><strong>Results: </strong>In seven animals, the bladder augmentation was successful without complication. One animal was lost in bowel obstruction and in two animals enteric fistula was found after the first intervention. The rectangular shape of the initial tissue expander was subsequently changed. All the seven patches were strong, compliant and had integrated with the surrounding native bladder and were 83% (48-100%) of the original patch size. Laser speckle contrast imaging already showed microcirculation at the patch edges at augmentation and this further improved towards the centre of the patches by the end of the study. Histology demonstrated acute inflammatory response with fibroblast infiltration after implantation and full coverage by urothelium was seen with positive staining for CK7 antibodies.</p><p><strong>Conclusion: </strong>Pre-vascularization of PABM in the omentum of healthy porcine models allows larger PABM patches to integrate this may be a step towards clinical application.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"40 1","pages":"308"},"PeriodicalIF":1.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative determinants of normative postoperative recovery rate following minimally invasive repair of pectus excavatum.","authors":"Michela Carter, Austin R Chen, J Benjamin Pitt, Rui Hua, Arianna Edobor, Soyang Kwon, Seth D Goldstein, Hassan M K Ghomrawi, Fizan Abdullah","doi":"10.1007/s00383-024-05889-5","DOIUrl":"10.1007/s00383-024-05889-5","url":null,"abstract":"<p><strong>Purpose: </strong>Recovery after minimally invasive repair of pectus excavatum (MIRPE) is prolonged. The purpose of this prospective study was to enhance our understanding of post-MIRPE recovery by following patients' recovery through postoperative day (POD) 60 using wearable devices and determine if recovery rate is impacted by PE severity and preoperative physical activity (PA) level.</p><p><strong>Methods: </strong>Children ≤ 18 years who underwent MIRPE with cryoablation between 8/2023 and 1/2024 wore a Fitbit™ for ≥ 3 days preoperatively to determine preoperative PA and through POD 60. The recovery trajectory, defined by postoperative daily step count divided by mean preoperative daily step count, was fit by power function through POD 60 among patients with uncomplicated recovery. Subgroup analyses were performed to compare recovery by PE severity and preoperative PA level.</p><p><strong>Results: </strong>Sixteen patients met criteria (68.8% male, mean [SD] age 15.4 [1.6] years). Recovery trajectory analysis demonstrated recovery on POD 60 was 84.8% (95CI 79.0-90.6%). On subgroup analysis, patients with Correction Index > 40% and preoperative mean steps/day ≥ 10,000 had faster recovery.</p><p><strong>Conclusions: </strong>Patients undergoing MIRPE with cryotherapy who are more active preoperatively or have higher Correction Indices were found to have accelerated recovery trajectories. These results may provide insight for preoperative counselling and interventions to optimize post-MIRPE recovery.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"40 1","pages":"309"},"PeriodicalIF":1.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Responding to the challenges of Global Children Surgery: a unique program in Burkina Faso.","authors":"Sophie Inglin, Anata Bara, Yacouba Traoré, Saïd N Ganame, Abou Coulibaly, Bertille Ki, Seydou Barro, Karim Barro, Emile Bandre, Seni Kouanda, Barbara E Wildhaber","doi":"10.1007/s00383-024-05903-w","DOIUrl":"10.1007/s00383-024-05903-w","url":null,"abstract":"<p><strong>Purpose: </strong>The challenges are immense when it comes to enhancing the development of pediatric surgery in low- and middle-income countries in line with current recommendations for holistic and sustainable approaches. The Pediatric surgery development plan in Burkina Faso was started in 2020. This paper reports on our unique experience, focusing on the main actions and indicators monitored.</p><p><strong>Methods: </strong>The program was developed based on the core principles of the Global Initiative for Children's Surgery, employing a comprehensive health system-strengthening strategy. Our approach aimed to address the pediatric surgical ecosystem through partnerships, research, and interventions at all levels of the healthcare system.</p><p><strong>Results: </strong>Significant actions were implemented across various domains, including infrastructure, quality of care, workforce, community awareness, research, and advocacy. These efforts have led to a substantial strengthening of the pediatric surgical ecosystem in the country, achieving major milestones and outcomes in each of these areas.</p><p><strong>Conclusion: </strong>This program has not only helped to create a major impulse for the expansion of pediatric surgery in Burkina Faso, but also enriched the community of interest with a robust implementation program to confirm the main challenge to succeed: integrating this most essential discipline into the wider framework of global health.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"40 1","pages":"310"},"PeriodicalIF":1.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A decade of managing pediatric major traumatic vascular injuries: insights from a referral center.","authors":"Norhafiza Ab Rahman, Dirk von Delft, Alp Numanoglu, Edre Mohammad Aidid, Marion Arnold","doi":"10.1007/s00383-024-05887-7","DOIUrl":"10.1007/s00383-024-05887-7","url":null,"abstract":"<p><strong>Purpose: </strong>Incidence, management, and outcomes of pediatric vascular injuries secondary to non-iatrogenic trauma were reviewed over a decade in our institution.</p><p><strong>Methods: </strong>A retrospective review of medical records (2013-2022) of major traumatic vascular injuries, focusing on injury profiles, treatment modalities, and clinical outcomes.</p><p><strong>Results: </strong>Thirty patients with 48 vessel injuries were included. Firearms were the leading mechanism, accounting for 43.3% (n = 13) of cases. We identified 29 arterial injuries and 19 venous injuries, with 30 (62.5%) of the overall injuries occurred in the lower extremities. Shock (17; 56.7%) and associated injuries (25; 83.3%) were common. Surgery was the most common management strategy. Autologous bypass graft was the most frequently performed procedure for arterial injuries (8; 42.1%), while ligation dominated in venous injuries (9; 64.3%). Blood transfusion requirements (24; 82.7%) and post-operative prescription of anticoagulant and antiplatelet agents (12; 41.4%) were similar for arterial and venous injuries (p > 0.05). Three patients demised, resulting in a 90% survival rate. Neither the mechanism of injury, anatomical location, and presence of shock on arrival nor the baseline hemoglobin level served as predictors of mortality.</p><p><strong>Conclusion: </strong>Intensive resuscitation with blood transfusion and prompt surgical intervention achieve favorable survival rates for pediatric traumatic vascular injuries. Optimal post-operative anticoagulant and antiplatelet regimens remain unclear.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"40 1","pages":"306"},"PeriodicalIF":1.5,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Favorable inhibitory effect of clodronate on hepatic steatosis in short bowel syndrome model rats.","authors":"Yudai Tsuruno, Ayaka Nagano, Koshiro Sugita, Shun Onishi, Yumiko Tabata, Chihiro Kedoin, Masakazu Murakami, Keisuke Yano, Takafumi Kawano, Nao Hasuzawa, Masatoshi Nomura, Tatsuru Kaji, Yuko Bitoh, Satoshi Ieiri","doi":"10.1007/s00383-024-05858-y","DOIUrl":"10.1007/s00383-024-05858-y","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigated the anti-inflammatory effect of clodronate, a vesicular nucleotide transporter (VNUT) inhibitor, on intestinal-failure-associated liver disease (IFALD) in a rat model of short bowel syndrome (SBS).</p><p><strong>Methods: </strong>The rats underwent jugular vein catheterization for continuous total parenteral nutrition (TPN) and 90% small bowel resection. The animals were divided into the following groups: TPN/SBS (Control group), TPN/SBS/intravenous administration of low-dose clodronate (20 mg/kg twice per week; Low group), or TPN/SBS/intravenous administration of high-dose clodronate (60 mg/kg twice per week; High group). On day 7, the rats were euthanized. Hepatic steatosis and hepatocellular injury were also assessed.</p><p><strong>Results: </strong>Hepatic steatosis and lobular inflammation in the liver were observed in all groups. The High group showed histologically reduced hepatic steatosis compared with the Control group. IL-6 and Nlrp3 expression in the High group was significantly suppressed compared to that in the Control group. The expression of other inflammatory cytokines tended to be lower in the High dose group than in the control group. The lipid metabolism gene expression in the liver specimens showed no significant differences among the groups.</p><p><strong>Conclusion: </strong>The high-dose administration of clodronate may, therefore, inhibit hepatic steatosis and inflammation associated with IFALD in patients with SBS.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"40 1","pages":"307"},"PeriodicalIF":1.5,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracotomy patch repair of large diaphragmatic herniae in a porcine model: a tale of two patches.","authors":"Dermot T McDowell, Tegan Cheng, Alexandre Darani, Raf Dye, Susan Arbuckle, Ralph C Cohen","doi":"10.1007/s00383-024-05893-9","DOIUrl":"10.1007/s00383-024-05893-9","url":null,"abstract":"<p><strong>Purpose: </strong>Congenital diaphragmatic herniae (CDH) may require patch closure in 50% of the cases. We assessed a biologic and composite mesh in a porcine CDH model.</p><p><strong>Methods: </strong>Left sided thoracotomy was performed in 20 pigs. Approximately, 30% of the diaphragm was excised and the patch (Surgisis® or Parietex®) inserted to close this defect. The pigs were killed at 6 months and the diaphragm was harvested for biomechanical and histological assessment.</p><p><strong>Results: </strong>The mean weight of the pigs at surgery and killing were 6.1 kg (4.2-8.4 kg) and 94.1 kg (80-131 kg), respectively. There were two recurrences and three eventrations, all with Surgisis®. There were less dense lung and abdominal adhesions in the Parietex group (P < 0.0001 and 0.025, respectively). The tensile strength of the Surgisis®, the Parietex® groups and controls were similar. There was significantly more muscle in-growth in the Parietex® patch over Surgisis® (p = 0.016).</p><p><strong>Conclusion: </strong>Parietex® and Surgisis® patches at 6 months have a similar tensile strength to normal tissue. All recurrences and eventrations were in the Surgisis® group. Parietex® patches demonstrated more muscle in-growth into the patch compared to Surgisis®. This is the first study utilising Parietex® composite patch in the repair of large diaphragmatic defects in a porcine model.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"40 1","pages":"305"},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors contributing to parental stress in newborns requiring surgical care: a cross-sectional study.","authors":"Veerabhadra Radhakrishna, Bahubali Deepak Gadgade, Nitin Kumar, Raghunath Bangalore Vasudev, Alladi Anand, Mamatha Basavaraju, Raghu Sampalli Ramareddy, Venkatesh Kesarla Lakshmaiah","doi":"10.1007/s00383-024-05901-y","DOIUrl":"10.1007/s00383-024-05901-y","url":null,"abstract":"<p><strong>Purpose: </strong>To assess parental stress in newborns undergoing surgical care.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in the Department of Pediatric Surgery at a tertiary center. The study included all parents of newborns requiring surgery, admitted between July 2023 and June 2024.</p><p><strong>Results: </strong>The overall stress score among the study population was 3.3 ± 1. Approximately 90% of parents reported experiencing at least some level of stress (stress score ≥ 2), with the \"parental role alteration\" domain scoring the highest (3.9 ± 1.1). In the \"surgical aspects\" domain, 27% reported extreme stress and 22% reported high stress. Higher stress scores were found among parents of preterm infants (3.6 ± 0.9 vs. 3.1 ± 1.1, p = 0.04), infants with a birth order ≥ 2 (3.4 ± 1.1 vs. 3.1 ± 1, p = 0.04), and those from the Muslim community. Graduate parents (2.8 ± 0.9, p = 0.01) and parents of upper socioeconomic status (2.3 ± 0.7, p < 0.0001) were found to have lower stress scores.</p><p><strong>Conclusion: </strong>Parental stress is significant among surgical newborns, especially in parents of preterm babies, babies with severe medical conditions, and those with lower education and socioeconomic status. \"Parental role alteration\" was the most stressful aspect, highlighting the need for targeted support.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"40 1","pages":"303"},"PeriodicalIF":1.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}