Journal of Pediatric Pharmacology and Therapeutics最新文献

{"title":"Administration of Undiluted Famotidine IV Push at a Large Pediatric Academic Medical Center.","authors":"Alexandra Caballero, Alexander Wang, Ferras Bashqoy, Francis De Los Reyes, Joanna Tracy, Anasemon Saad","doi":"10.5863/JPPT-25-00036","DOIUrl":"10.5863/JPPT-25-00036","url":null,"abstract":"<p><strong>Objective: </strong>Famotidine is a commonly used agent in pediatric intensive care units. There is no data regarding the safety of undiluted intravenous push (IVP) administration in pediatrics; however, there are historical concerns for hemodynamic instability in the adult population. This study assesses the safety of famotidine administered undiluted IVP for doses ≥ 5 mg in pediatric patients.</p><p><strong>Methods: </strong>We performed a retrospective, observational, medication use evaluation in pediatric patients (≤ 18 years) who received famotidine undiluted IVP from February to July 2022. Patients with arterial lines and continuous cardiac telemetry were included. Patients requiring extracorporeal membrane oxygenation, receiving famotidine doses < 5 mg, or who had a change in vasoactive medication doses within 1 hour prior to famotidine IVP administration were excluded. The primary outcome was the incidence of hypotension and bradycardia within 45 minutes of undiluted famotidine IVP administration.</p><p><strong>Results: </strong>A total of 59 patients were included. There were 8 patients (13.6%) with hypotension and 1 patient (1.7%) with bradycardia after famotidine administration in the full cohort. Of these 9 patients, 7 had hypotension and bradycardia at baseline. Two patients (3.4%) required adjustment of their vasoactive medication within 45 minutes after receiving famotidine, although these patients were also postoperative day zero from cardiac surgery. None of the patients required a fluid bolus for hypotension following famotidine administration. The percent change in hemodynamics from baseline were minimal across the various time intervals.</p><p><strong>Conclusion: </strong>Famotidine administered undiluted IVP produced no clinically significant hemodynamic -adverse effects in critically ill pediatric patients.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 2","pages":"214-218"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692900","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":"A Pilot Study of Cefepime and Meropenem Therapeutic Drug Monitoring in Pediatric Patients on Extracorporeal Therapy.","authors":"Kaitlin M McFarland, Christina J Smith, Sai Karwande, Adam W Brothers","doi":"10.5863/JPPT-25-00050","DOIUrl":"10.5863/JPPT-25-00050","url":null,"abstract":"<p><strong>Objective: </strong>Patients on extracorporeal therapy receiving medications have the potential for large pharmacokinetic shifts. Data supporting dose adjustments for antibiotics in pediatric patients on extracorporeal membrane oxygenation (ECMO) or continuous renal replacement therapy (CRRT) are limited. Institutional data reveal that cefepime and meropenem troughs are often outside of goal ranges for patients on extracorporeal therapies. The objective of this research was to elucidate potential patterns between clinical characteristics, extracorporeal modalities, and total serum trough concentrations of cefepime and meropenem.</p><p><strong>Methods: </strong>This retrospective chart review evaluated all patients during the study period with a cefepime or meropenem serum concentration obtained while on ECMO or CRRT. Clinical circumstances were reported, and descriptive statistics were performed on various subgroups to determine which subpopulations experienced more out-of-range drug trough concentrations.</p><p><strong>Results: </strong>Twenty-one cefepime serum trough concentrations were reviewed for 11 patients, with the mean and median concentrations exceeding the pre-defined goal range. Fifty percent of serum cefepime concentrations from 6 patients on ECMO were supratherapeutic, whereas 92.9% of serum cefepime concentrations from 7 patients on CRRT were supratherapeutic. Seven serum meropenem concentrations were reviewed for 5 patients, and the mean, median, and IQR of the serum troughs were all within goal range, regardless of extracorporeal therapy used. All cefepime and meropenem serum trough concentrations that were collected after a pause in CRRT of at least 1 hour within the previous 24 hours exceeded the goal ranges. One possible neurotoxic event was identified in a patient receiving cefepime and CRRT.</p><p><strong>Conclusions: </strong>Pharmacists and providers should ensure that pauses in CRRT are accounted for when dosing these antibiotics and should be aware that standard cefepime dosing for these patients often leads to elevated trough concentrations.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 2","pages":"243-250"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692891","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":"Elevated Serum Concentrations of Lacosamide and Perampanel in a Pediatric Patient Following Coadministration of Clarithromycin for <i>Mycoplasma pneumoniae</i> Pneumonia.","authors":"Shotaro Meguro, Toru Imai, Wakako Ishii, Emiko Momoki, Tadayasu Kawaguchi, Kengo Matsuda, Shintaro Watanabe, Susumu Ootsuka","doi":"10.5863/JPPT-25-00087","DOIUrl":"10.5863/JPPT-25-00087","url":null,"abstract":"<p><p>Lacosamide (LCM) and perampanel (PER) are antiepileptic drugs eliminated, in part, by cytochrome P450 (CYP) 3A4. However, clinical reports of their interactions are limited. Here, we report the case of a 12-year-old girl with a history of infantile epileptic spasms syndrome, treated with LCM, PER, valproic acid (VPA), and levetiracetam (LEV), who was diagnosed with <i>Mycoplasma pneumoniae</i> pneumonia and prescribed clarithromycin (CAM). Owing to impaired consciousness, serum drug concentrations were measured on multiple occasions during hospitalization. Markedly elevated serum concentrations of LCM (2.3 × baseline) and PER (4.4 × baseline) were observed after initiation of CAM. These concentrations were normalized after CAM was discontinued. Serum concentrations of LEV and VPA remained unchanged. According to the Drug Interaction Probability Scale, interaction was considered probable, with a total score of 5. Clarithromycin likely induced a pharmacokinetic interaction via CYP3A4 inhibition, leading to increased serum concentrations of LCM and PER. Although the concomitant use of CAM with these agents is not contraindicated, the findings of this case suggest caution is warranted. When macrolide therapy is necessary, alternative agents with weaker CYP3A4 inhibition, such as azithromycin, may be preferable.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 2","pages":"256-261"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692909","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":"Albumin and Other Plasma Proteins in Pediatric Patients: What, When, and How Much They Influence Antimicrobial Pharmacology.","authors":"Jacopo Angelini, Francesco Russiani, Sara Ferin, Sarah Flammini, Carlo Tascini, Jason A Roberts, Massimo Baraldo, Simone Giuliano","doi":"10.5863/JPPT-25-01215","DOIUrl":"10.5863/JPPT-25-01215","url":null,"abstract":"<p><p>Plasma proteins play a critical role in antimicrobial drug exposure, particularly in special populations where protein concentrations and binding capacity may be altered. This review summarizes current knowledge on age-related changes in plasma protein concentrations and protein-binding variability, with a specific focus on pediatric populations. This variability can lead to substantial alterations in the unbound fraction of many antimicrobials, especially those that are highly protein-bound. Understanding these pharmacokinetic changes is fundamental for safe and effective antimicrobial dosing in particular patients such as pediatric patients, who may require specific dose adjustments based on the various stages of their physiological development, from birth to adolescence. During this growth period, each developmental stage may represent a clinical setting with distinctive characteristics that clinicians must consider when choosing the drug and its dosage, because pharmacokinetic parameters may change within a shorter and more variable time frame than observed in adult patients. In this context therapeutic drug monitoring (TDM) represents a key strategy for optimizing drug dosing and achieving target therapeutic drug concentrations.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 2","pages":"292-301"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692843","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":"Evaluating LLM Integration in Pharmacometrics Through a Software Development Perspective.","authors":"Kyle Barrett, Samuel P Callisto","doi":"10.5863/JPPT-25-01208","DOIUrl":"10.5863/JPPT-25-01208","url":null,"abstract":"","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 2","pages":"279-283"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692906","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":"Pediatric Antibiotic Prescribing Patterns From Emergency Department Visits.","authors":"Scott Gutovitz, Sarah Astrab, Hannah Chotiner, Justin Blaskowsky, Sarah Meier, Hannah Minton, Lauren Jacobs, Alexis Chlada, Sarah Kleist","doi":"10.5863/JPPT-25-00007","DOIUrl":"10.5863/JPPT-25-00007","url":null,"abstract":"<p><strong>Objectives: </strong>Antibiotics are frequently prescribed for pediatric emergency department (ED) patients having respiratory or genitourinary infections. Professional guidelines and antibiograms exist to help guide appropriate antibiotics for these infections, but it is unknown how well ED providers adhere to these recommendations.</p><p><strong>Methods: </strong>From January 1, 2017 to December 31, 2022 using a national electronic medical record database, we retrospectively reviewed de-identified pediatric ED patients who were discharged home with an antibiotic. Antibiotics and infections were grouped for analysis, and results were compared yearly.</p><p><strong>Results: </strong>We identified 85,026 pediatric ED patients with infectious diseases discharged home with 24,363 antibiotic prescriptions. Over the 6-year study period, penicillin-based antibiotics were prescribed more than macrolides or cephalosporins for respiratory tract infections, rising from 76.5% in 2017 to 81.3% in 2022 (p < 0.001). For genitourinary tract infections, cephalosporins were prescribed more than 5 other types of antibiotics, rising from 62.7% in 2017 to 73.9% in 2022 (p < 0.001).</p><p><strong>Conclusions: </strong>Over this 6-year period, ED providers in our region were fairly adherent to and improved for guideline recommended respiratory tract infections and antibiogram guided treatment for genitourinary tract infection in pediatric patients.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 2","pages":"251-255"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692923","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":"Identification and Characterization of Mitragynine or 7-Hydroxymitraynine Oral Dosage Form Products That Appeal to Children.","authors":"C Michael White, Mia Atallah, Dana El Khoury","doi":"10.5863/JPPT-25-00082","DOIUrl":"10.5863/JPPT-25-00082","url":null,"abstract":"<p><strong>Objective: </strong>Kratom is the pulverized dried leaves of the <i>Mitragyna speciosa</i> tree and has a bitter taste and high ingestion volume that repels children. Newer products use a single alkaloid extract from the leaves, mitragynine, or oxidize mitragynine to 7-hydroxymitragynine and place it in various oral dosage forms. We identified oral dosage form products containing mitragynine and/or 7-hydroxymitragynine that are marketed in ways that appeal to children and define their alluring characteristics.</p><p><strong>Methods: </strong>We performed Google searches to identify websites selling kratom products. Products were assessed and included if they had 1 or more features that would be attractive to children and defined their formulations, alkaloids, flavoring/scents, mascots, and packaging.</p><p><strong>Results: </strong>Eighty unique products that appealed to children were found, and 36.3% were gummies, 28.8% were tablets, 18.8% were drink mixes or liquids, 15.0% were miscellaneous candies (saltwater taffies, ice cream cones, noobs, popping crystals, honey sticks, mints, lollipops), and 1.3% were chocolates. Thirty-eight products (47.5%) contained mitragynine, 35 products (43.8%) contained 7-hydroxymitragynine, 6 products (7.5%) contained both, and 1 product (1.3%) did not specify which alkaloid was included. Twenty-six products (32.5%) had a cartoon mascot or symbol. Sixty-six products (82.5%) had brightly colored packaging, 59 products (73.8%) had brightly colored formulations, and 73 formulations (91.3%) had a flavor or scent.</p><p><strong>Conclusions: </strong>Mitragynine and 7-hydroxymitragynine are present in many products that could cause small children and teens to be exposed.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 2","pages":"238-242"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692878","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":"Low-Dose Versus High-Dose Methylprednisolone and Impact on Duration of Noninvasive Bilevel Positive Airway Pressure in Pediatric Severe Asthma Exacerbations.","authors":"Alyssa Wallace, Sarah Belz, Jessica Lundeen, Elizabeth Elliott, Parisa Kaviany, Matthew Sharron, Boh Song","doi":"10.5863/JPPT-24-00119","DOIUrl":"10.5863/JPPT-24-00119","url":null,"abstract":"<p><strong>Objective: </strong>Corticosteroids are frequently used in asthma exacerbation management; however, there are few data on optimal dosing for patients needing positive pressure ventilation. The purpose of this study is to investigate the relationship between steroid dosing and asthma outcomes, specifically as it relates to patients admitted to the pediatric intensive care unit (PICU) who require noninvasive bilevel positive airway pressure (NBPAP) ventilation.</p><p><strong>Methods: </strong>This retrospective study evaluated patients older than 2 years, admitted to the PICU and initiated on NBPAP for an asthma exacerbation during the study period. The methylprednisolone low-dose (0.5 mg/kg/dose with a maximum of 15 mg every 6 hours) and high-dose (1 mg/kg/dose with a maximum of 60 mg every 6 hours) strategies were used to determine the cohorts. The NBPAP duration and PICU and hospital length of stay were recorded.</p><p><strong>Results: </strong>A total of 197 patients were included in the study: 95 patients made up the low-dose cohort and 102 patients were in the high-dose cohort. The patients in the low-dose cohort had a median time on NBPAP of 25.2 hours compared with 25.5 hours in the high-dose cohort (p = 0.949). There was also no -difference in PICU and hospital length of stay as well as inpatient steroid duration.</p><p><strong>Conclusions: </strong>No difference was observed between low-dose and high-dose methylprednisolone on -duration of NBPAP in pediatric severe asthma exacerbations.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 2","pages":"226-232"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692860","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":"Hypotonia and Lethargy as Potential Adverse Effect to Nirsevimab Administration in a Newborn Infant.","authors":"Virginia María Velasco Molina, María Nimo Mallo, Samantha Tandrón Del Río, Paloma López-Ortego, Gonzalo Solís-García","doi":"10.5863/JPPT-25-00013","DOIUrl":"10.5863/JPPT-25-00013","url":null,"abstract":"<p><p>Respiratory syncytial virus (RSV) is one of the most common causes of acute lower respiratory tract infections in children. Immunization with nirsevimab has had a positive impact in reducing the number of emergency department (ED) visits for RSV. Clinical trials have shown that most adverse events associated with nirsevimab administration were mild, with no significant difference compared with placebo. We report on a 13-day-old female newborn who was brought into the ED because of hypotonia and unresponsiveness after administration of nirsevimab. During the 48-hour hospital stay, the only relevant clinical finding was mild axial hypotonia, which gradually resolved without treatment. A cerebral function monitor showed a continuous normal voltage tracing with no signs of seizures, and a complete electroencephalogram revealed normal background activity. Given that all the investigations were normal and the main event preceding the events was the administration of immunoprophylaxis with nirsevimab, a possible association between the clinical symptoms and the medication was suggested. Although there is robust evidence to recommend nirsevimab for reducing hospitalizations, we must bear in mind that, as a relatively new drug, we believe it is essential to emphasize continued monitoring of side effects, particularly in neonates.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 2","pages":"262-265"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692926","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":"Enoxaparin Dosing and Target anti-Factor Xa Achievement in Infants by Postmenstrual Age.","authors":"Densley Perez, Kristen Mathew","doi":"10.5863/JPPT-25-00079","DOIUrl":"10.5863/JPPT-25-00079","url":null,"abstract":"<p><strong>Objective: </strong>Currently, there is little literature delineating the optimal doses of enoxaparin required within the premature and infant populations. This study aims to assess the enoxaparin dose needed to achieve therapeutic anti-factor Xa concentrations through stratifying infants by postmenstrual age (PMA).</p><p><strong>Methods: </strong>This is a retrospective, single-center, cohort study of infants who received at least 1 dose of treatment enoxaparin between September 2020 and September 2023. The primary endpoint was dose required to achieve therapeutic anti-factor Xa concentrations stratified by PMA group. Secondary endpoints were time in therapeutic range, average dose throughout course, number of dose adjustments and rates of bleeding and acute kidney injury.</p><p><strong>Results: </strong>Eighty-four patient encounters met inclusion criteria in which there were 108 unique courses of enoxaparin. Subjects were primarily of term gestation (median 37.5 weeks) and admitted for congenital heart disease (79.8%). The dose needed to achieve the first therapeutic anti-factor Xa concentration by course was significantly different based on PMA (p < 0.001): median 1.80 mg/kg (IQR 1.53-2.20 mg/kg) with PMA < 40 weeks, 1.64 mg/kg (IQR 1.55-1.77 mg/kg) with PMA 40 to 44 weeks and 1.49 mg/kg (IQR 1.19-1.74 mg/kg) with PMA >44 weeks. The median time in therapeutic range was 71% (IQR 53%-90%) per course. Overall, there were 6 cases of bleeding (5 were classified as minimal and none as severe).</p><p><strong>Conclusions: </strong>Subjects with lower postmenstrual ages required significantly higher enoxaparin doses to achieve therapeutic anti-factor Xa concentrations. Postmenstrual age may provide a more appropriate basis for dosing enoxaparin compared with gestational age and postnatal age.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 2","pages":"219-225"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692903","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}