Respiratory investigation最新文献

{"title":"Exploratory study of factors associated with probable respiratory sarcopenia in elderly subjects","authors":"Takuya Umehara ,&nbsp;Akinori Kaneguchi ,&nbsp;Takahiro Yamasaki ,&nbsp;Nobuhiro Kito","doi":"10.1016/j.resinv.2024.06.009","DOIUrl":"10.1016/j.resinv.2024.06.009","url":null,"abstract":"<div><h3>Background</h3><p>The diagnostic criteria for respiratory sarcopenia have been recently reported. However, no studies have clarified the characteristics of skeletal muscle impairment of the limbs in subjects with respiratory sarcopenia. This study aimed to explore the factors, including skeletal muscle, associated with probable respiratory sarcopenia in elderly subjects.</p></div><div><h3>Methods</h3><p>Subjects were classified into the probable respiratory sarcopenia group and nonrespiratory sarcopenia group. Probable respiratory sarcopenia was defined as the concurrent presence of respiratory muscle weakness (as less than the predicted value calculated from age, sex, and height) and low skeletal muscle mass (&lt;7.0 kg/m² in males and 5.7 kg/m² in females). The following factors were measured: respiratory muscle strength, skeletal muscle mass index, muscle thickness and echo intensity of the rectus femoris, extracellular-to-intracellular water ratio, hand grip strength, 5 sit-to-stand, knee extension strength, bone mineral density, age, sex, body mass index, degree of frailty, presence or absence of medical history, presence or absence of habitual exercise, period of time since the start of exercise, and number of hours of exercise at a time. The association subjects with probable respiratory sarcopenia were analyzed using hierarchical logistic regression analysis.</p></div><div><h3>Results</h3><p>Twenty-six with probable respiratory sarcopenia and 54 with nonrespiratory sarcopenia were included. Hierarchical logistic regression analysis revealed that echo intensity was a significant predictor of probable respiratory sarcopenia. The odds ratio for echo intensity was 2.54 (95% confidence interval: 1.04–6.23).</p></div><div><h3>Conclusions</h3><p>Our results suggest that a decrease in muscle quality in the lower extremity is associated with probable respiratory sarcopenia.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 5","pages":"Pages 773-777"},"PeriodicalIF":2.4,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555370","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":"The remarkable antitumor efficacy of corticosteroid treatment in patients with refractory thymomas","authors":"Tomohiro Tanaka ,&nbsp;Yasushi Goto ,&nbsp;Ken Masuda ,&nbsp;Yuki Shinno ,&nbsp;Yuji Matsumoto ,&nbsp;Yusuke Okuma ,&nbsp;Tatsuya Yoshida ,&nbsp;Hidehito Horinouchi ,&nbsp;Noboru Yamamoto ,&nbsp;Yuichiro Ohe","doi":"10.1016/j.resinv.2024.06.008","DOIUrl":"10.1016/j.resinv.2024.06.008","url":null,"abstract":"<div><h3>Background</h3><p>Some case reports have found that corticosteroid treatments shrunk thymoma lesions remarkably after the failure of chemotherapy or surgery. However, few studies have comprehensibly evaluated the antitumor effects of corticosteroids in patients with invasive thymomas.</p></div><div><h3>Methods</h3><p>We reviewed the medical records of 13 consecutively enrolled patients with locally advanced or metastatic thymomas treated via corticosteroid monotherapies from January 2010 to March 2021 in our institute. A Cox's proportional hazard model and the Kaplan-Meier method were used to identify factors associated with survival.</p></div><div><h3>Results</h3><p>The median follow-up time was 26 months (range, 13–115 months). The median initial dose of corticosteroid was 0.90 mg/kg/day prednisolone equivalent (range, 0.4–1.1 mg/kg/day). Of the 13 cases, 7 (53.8%, 95% CI: 0.25–0.81) exhibited a partial response and 5 (38.5%, 95% CI: 0.14–0.68) stable disease. The median progression-free survival was 5.7 months [95% confidence interval (CI): 1.5–9.6 months]. The median overall survival was 25.3 months (95% CI: 7.1–not attained). The median duration of corticosteroid use was 3 months (range, 1–64 months). Patients with WHO subtype B thymomas exhibited a better overall response rate to corticosteroids than did patients with other disease subtypes (75%, 95% CI: 0.19–0.99). Adverse events of Grade 3 or more were not observed.</p></div><div><h3>Conclusions</h3><p>Corticosteroids are clinically valuable for patients with thymomas.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 5","pages":"Pages 766-772"},"PeriodicalIF":2.4,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535150","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":"Remission of hypersensitivity pneumonitis after allogeneic hematopoietic stem cell transplantation","authors":"Yumi Inukai Motokura ,&nbsp;Hisao Higo ,&nbsp;Chiaki Matsumoto ,&nbsp;Mari Uno ,&nbsp;Kanako Fujiwara ,&nbsp;Toshiki Terao ,&nbsp;Satoko Makimoto ,&nbsp;Fumiyo Higaki ,&nbsp;Ken-ichi Matsuoka ,&nbsp;Fumiaki Tokioka ,&nbsp;Yoshinobu Maeda ,&nbsp;Nobuaki Miyahara","doi":"10.1016/j.resinv.2024.06.007","DOIUrl":"https://doi.org/10.1016/j.resinv.2024.06.007","url":null,"abstract":"<div><p>A 50-year-old man was diagnosed with hypersensitivity pneumonitis caused by the environment of his bar owing to worsening symptoms, laboratory test results, and computed tomography images after an environmental inhalation challenge test. His hypersensitivity pneumonitis exacerbated despite receiving prednisolone 20 mg/day. The patient underwent allogeneic hematopoietic stem cell transplantation (HSCT) from a human leukocyte antigen-matched unrelated donor for myelodysplastic syndrome. No exacerbation of hypersensitivity pneumonitis was observed after HSCT. An environmental inhalation challenge test involving exposure to his bar confirmed the remission of hypersensitivity pneumonitis after HSCT. This case demonstrates that hypersensitivity pneumonitis can be remitted by HSCT.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 5","pages":"Pages 759-761"},"PeriodicalIF":2.4,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141480150","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":"Favorable clinical course after discontinuation of omalizumab treatment in patients with allergic severe asthma: A real-world clinical practice","authors":"Satoshi Hamada ,&nbsp;Eriko Ogino ,&nbsp;Hirotaka Yasuba","doi":"10.1016/j.resinv.2024.06.005","DOIUrl":"https://doi.org/10.1016/j.resinv.2024.06.005","url":null,"abstract":"<div><p>The success rate of omalizumab discontinuation is 50–75.5%. However, such data are scarce in Japan. We retrospectively investigated the clinical progression following the cessation of long-term omalizumab treatment (&gt;5 years) in severe allergic asthma patients who have achieved super-responder status, defined as being off any oral maintenance corticosteroids without experiencing exacerbations requiring systemic corticosteroids for &gt;1 year. Six (28.6%) among 21 patients recommenced after a median period of 5.5 (4.3–12.5) months later due to exacerbated asthma control, resulting in improved asthma management for all patients. The rates of patients who successfully remained off omalizumab treatment for 1 and 2 years were 72.4% and 65.8%, respectively. Specific IgE levels after discontinuing omalizumab treatment significantly decreased compared to those at initiating this treatment in 10 patients who successfully remained off this treatment. Therefore, discontinuing omalizumab treatment may be considered for patients continuing treatment beyond 5 years and achieving super-responder status.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 5","pages":"Pages 762-765"},"PeriodicalIF":2.4,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141480149","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":"Gastroesophageal reflux disease in chronic obstructive pulmonary disease","authors":"Kazuya Tanimura,&nbsp;Shigeo Muro","doi":"10.1016/j.resinv.2024.06.004","DOIUrl":"10.1016/j.resinv.2024.06.004","url":null,"abstract":"<div><p>Gastroesophageal reflux disease (GERD) is one of the most common comorbidities of chronic obstructive pulmonary disease (COPD). Decreased lower and upper esophageal sphincter pressures, esophageal dysmotility, high transdiaphragmatic pressure, and decreased saliva secretion have been implicated as mechanisms leading to the development of GERD in COPD. Clinically, comorbid GERD in COPD is reportedly associated with worse symptoms, quality of life, and lung function, as well as a high risk of exacerbations. Aspiration of regurgitation and the cholinergic-mediated esophagobronchial reflex play a significant role in the pathophysiology. Abnormal swallowing reflexes and discoordination of swallowing can worsen aspiration. The diagnosis of GERD is not based on a single criterion; however, various approaches, including questionnaires and endoscopic evaluations, can be widely applied in clinical settings. Due to the increased risk of esophageal and gastric cancers in patients with COPD, the threshold for endoscopic examination should be low. Acid inhibitory agents, such as proton pump inhibitors and histamine H2 receptor antagonists, and prokinetic agents, including mosapride and itopride, are clinically used to treat GERD. Endoscopic fundoplication can be performed in patients with GERD refractory to medical treatment. There is still insufficient evidence, but an increasing number of studies have suggested the clinical efficacy of treatment in patients with COPD and GERD. As GERD is an evaluative and treatable common disease, and access to evaluation and treatment is relatively easy, clinicians should provide adequate care for GERD in the management of COPD.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 5","pages":"Pages 746-758"},"PeriodicalIF":2.4,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470487","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":"Identification of patients with NSCLC undergoing multiplex gene analysis that also require comprehensive genomic profiling","authors":"Ryuji Hayashi","doi":"10.1016/j.resinv.2024.04.022","DOIUrl":"https://doi.org/10.1016/j.resinv.2024.04.022","url":null,"abstract":"","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 5","pages":"Pages 744-745"},"PeriodicalIF":2.4,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433803","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":"Factors associated with readmission for community-onset pneumonia among older people: A retrospective study","authors":"Akihiko Goto ,&nbsp;Kenji Umeki ,&nbsp;Kazufumi Hiramatsu ,&nbsp;Jun-ichi Kadota ,&nbsp;Kosaku Komiya","doi":"10.1016/j.resinv.2024.06.002","DOIUrl":"https://doi.org/10.1016/j.resinv.2024.06.002","url":null,"abstract":"<div><h3>Background</h3><p>Although older individuals are prone to pneumonia relapse, little real-world evidence is available on the main factors contributing to pneumonia recurrence. This study assessed the impact of patients’ lifestyles on hospital readmission due to pneumonia recurrence.</p></div><div><h3>Methods</h3><p>We retrospectively included consecutive patients (aged ≥65 years) who were admitted for community-onset pneumonia. A binary or multiple-choice postal questionnaire survey on lifestyles after hospitalization was conducted to identify the factors associated with readmission due to pneumonia recurrence.</p></div><div><h3>Results</h3><p>Of 117 patients who responded to the questionnaires, 89 were included in the analyses after excluding 28 patients who died within 1 year of discharge. Twenty-four of 89 (27%) patients were readmitted to the hospital for pneumonia within 1 year of discharge. Multivariate analysis revealed that cerebrovascular disease (odds ratio [OR], 3.912; 95% confidence interval [CI], 1.104–13.861; p = 0.035) and need of assistance at mealtime (OR, 2.225; 95% CI, 1.182–4.186; p = 0.013) were significantly associated with readmission due to pneumonia recurrence. Oral care and mealtime body position were not associated with readmission.</p></div><div><h3>Conclusions</h3><p>Host factors, not patients’ lifestyles such as oral care and body position, mainly contribute to the development of pneumonia among older people. These results should be considered risk factors for readmission by medical workers and family members.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 5","pages":"Pages 739-743"},"PeriodicalIF":2.4,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141434771","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":"Novel method of attaching a suction tube externally to a tracheal tube as an insertion route for a Fogarty catheter in cryobiopsy: Retrospective comparative study","authors":"Hiroshi Ishimoto ,&nbsp;Noriho Sakamoto ,&nbsp;Daisuke Okuno ,&nbsp;Hirokazu Yura ,&nbsp;Mutsumi Ozasa ,&nbsp;Ritsuko Miyashita ,&nbsp;Takatomo Tokito ,&nbsp;Takashi Kido ,&nbsp;Shinnosuke Takemoto ,&nbsp;Takahiro Takazono ,&nbsp;Yasushi Obase ,&nbsp;Yuji Ishimatsu ,&nbsp;Tomoya Nishino ,&nbsp;Hiroshi Mukae","doi":"10.1016/j.resinv.2024.06.001","DOIUrl":"https://doi.org/10.1016/j.resinv.2024.06.001","url":null,"abstract":"<div><h3>Background</h3><p>Cryobiopsy use is anticipated to become more common in diagnosing lung diseases. In Japan, inserting a Fogarty catheter through a suction channel above the endotracheal tube's cuff for hemostasis is common practice. However, the rigid nature of the endotracheal tube poses challenges to tracheal intubation using a bronchoscope. The endotracheal tube cuff must be removed to prevent interference during Fogarty catheter insertion. To simplify the procedure and enhance safety, we devised and implemented a method of inserting a hemostatic Fogarty catheter with a suction tube externally attached to a softer endotracheal tube. This study aimed to evaluate the sustainability of this Fogarty catheter insertion method using suction tubes.</p></div><div><h3>Methods</h3><p>The hemostatic Fogarty catheter insertion method was retrospectively validated. We compared outcomes between 60 patients who underwent the conventional method with a suction channel above the cuff and 50 patients who underwent the novel approach with an externally attached suction tube.</p></div><div><h3>Results</h3><p>The physicians performing bronchoscopy and inserting the Fogarty catheter in the group in which the suction tube was externally attached for Fogarty catheter insertion had little experience. However, the overall bronchoscopy time was shorter; the two groups showed no significant differences in complications.</p></div><div><h3>Conclusion</h3><p>Regarding cryobiopsy procedures, using an externally attached suction tube for Fogarty catheter insertion was practical and comparable to the conventional method of using a suction channel above the cuff. This method made the procedure more simple and safe.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 4","pages":"Pages 732-737"},"PeriodicalIF":3.1,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2212534524000935/pdfft?md5=3d319577c45ee5a1919abd1e45efa291&pid=1-s2.0-S2212534524000935-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141323716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic yield of flexible bronchoscopy for immunocompromised patients with lung infiltrates: A single-center, retrospective study","authors":"Natsuki Nakagawa,&nbsp;Takahiro Ando,&nbsp;Masanori Kawakami,&nbsp;Keisuke Hosoki,&nbsp;Yoshihisa Hiraishi,&nbsp;Yu Mikami,&nbsp;Hidenori Kage","doi":"10.1016/j.resinv.2024.05.017","DOIUrl":"https://doi.org/10.1016/j.resinv.2024.05.017","url":null,"abstract":"<div><h3>Background</h3><p>Pulmonary complications are associated with mortality in immunocompromised patients. The usefulness of bronchoscopy has been reported. However, clinical factors and procedures that influence diagnostic yield are still not established.</p></div><div><h3>Materials and methods</h3><p>We retrospectively analyzed 115 bronchoscopies performed on 108 immunocompromised patients, defined as those who take corticosteroids and/or immunosuppressants. We evaluated clinical factors, sampling procedures, final diagnosis, and severe complications of bronchoscopy.</p></div><div><h3>Results</h3><p>The clinical diagnosis was obtained in 51 patients (44%). Of those, 33 cases were diagnosed as infectious diseases and 18 as non-infectious diseases. Nine out of 115 cases (7.8%) initiated new immunosuppressive treatment for an underlying disorder based on the negative microbiological results obtained with bronchoscopy. Collagen vascular disease was the most common underlying disorders (62 patients, 54%). Bronchoscopy was useful regardless of whether the patient was immunosuppressed to treat collagen vascular disease (P = 0.47). Performing transbronchial biopsy correlated with better diagnostic yield of bronchoscopy (54.7% vs 35.5%, P = 0.049). Other clinical factors, such as radiological findings, respiratory failure or antibiotic use at the time of bronchoscopy did not significantly influence diagnostic yield. Respiratory failure requiring intubation after bronchoscopy occurred only in one case (0.9%).</p></div><div><h3>Conclusions</h3><p>Our study implied the transbronchial biopsy may be a useful procedure for reaching a diagnosis in immunocompromised patients with pulmonary infiltrates. In addition, our data suggest the usefulness of bronchoscopy for immunocompromised patients due to the treatment of collagen vascular disease as well as other underlying disorders.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 4","pages":"Pages 726-731"},"PeriodicalIF":3.1,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141313423","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":"Treatment strategy for older patients with pneumonia independent of the risk of drug resistance in the world's top country for longevity","authors":"Kosaku Komiya ,&nbsp;Izumi Yamatani ,&nbsp;Jun-ichi Kadota","doi":"10.1016/j.resinv.2024.05.016","DOIUrl":"10.1016/j.resinv.2024.05.016","url":null,"abstract":"<div><p>The number of older people with impaired swallowing function increases with aging population. Aspiration pneumonia is one of the most cases of pneumonia developing among older people. As aspiration pneumonia may develop as a result of age-related deterioration, it is crucial to consider it as an unavoidable event with aging. While pneumonia is diagnosed based on respiratory symptoms and radiological features, the lung involvement of aspiration pneumonia may be undetectable via a frontal chest radiograph in some cases. Bacterial profiles show the predominance of drug-resistant bacteria, such as <em>Pseudomonas aeruginosa</em> and methicillin-resistant <em>Staphylococcus aureus</em> (MRSA), but isolated bacteria from respiratory samples do not necessarily indicate causative pathogens. Furthermore, there is no evidence regarding treatment superiority using broad-spectrum antibiotics compared with narrow-spectrum antibiotics. Even if isolated pathogens are a causative factor for pneumonia among older patients, the use of broad-spectrum antibiotics covering the bacteria may not improve their outcomes. Therefore, we propose a treatment strategy independent of the risk of drug resistance focusing on the discrimination of patients who are unlikely to respond to broad-spectrum antibiotics. An aspiration risk is associated with increased in-hospital mortality in patients with pneumonia, which could also lead to a greater risk of poor long-term outcomes with increased 1-year mortality. Advance care planning is now recognized as a process for communication and medical decision-making across the life course. This approach would be widely recommended for older people with aspiration risk.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 4","pages":"Pages 710-716"},"PeriodicalIF":3.1,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2212534524000911/pdfft?md5=5cfbf7b7db9225775e16c79dc5befae1&pid=1-s2.0-S2212534524000911-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141186863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}