Clinica e Investigacion en Arteriosclerosis最新文献

{"title":"Early detection of severe hypertriglyceridemia using teleconsultation in a clinical laboratory setting","authors":"","doi":"10.1016/j.arteri.2024.03.004","DOIUrl":"10.1016/j.arteri.2024.03.004","url":null,"abstract":"<div><h3>Background</h3><p>Teleconsultation in the context of clinical laboratories is a valuable tool for the early detection of dyslipidemia and prevention of cardiovascular risk. Here, we describe a patient who was referred to the Lipid Unit of the Virgen Macarena Hospital due to an alert for severe hypertriglyceridemia through its teleconsultation program.</p></div><div><h3>Case presentation</h3><p>A comprehensive clinical and biochemical study of the patient was carried out, and genetic testing was performed on the patient and his family. The proband and his family showed mild to severe hypertriglyceridemia and various secondary factors, together with a genetic background associated with a triglyceride-raising effect.</p></div><div><h3>Conclusion</h3><p>This extensive study has identified a family at high risk of cardiovascular disease and acute pancreatitis. These findings can help maximize lifestyle changes and improve the clinical management of their dyslipidemia.</p></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":"36 5","pages":"Pages 299-302"},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869634","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":"Apnea obstructiva del sueño y riesgo cardiovascular","authors":"Gerard Torres ,&nbsp;Manuel Sánchez de la Torre ,&nbsp;Lucia Pinilla ,&nbsp;Ferran Barbé","doi":"10.1016/j.arteri.2024.01.004","DOIUrl":"10.1016/j.arteri.2024.01.004","url":null,"abstract":"<div><p>Patients with obstructive sleep apnea (OSA) experience repetitive episodes of upper airway obstruction due to recurrent collapse during sleep. This leads to intermittent hypoxia episodes, which, through complex pathophysiological mechanisms, trigger sympathetic overactivation, endothelial dysfunction, hypercoagulation, and metabolic dysregulation. Consequently, other cardiovascular risk factors such as hypertension, metabolic syndrome, and diabetes are induced. Furthermore, this enhances target organ damage, affecting the heart, arteries, and kidneys, leading to an increased risk of cardiovascular morbidity and mortality. Among the various treatments for OSA, Continuous Positive Airway Pressure (CPAP) has been extensively studied. To date, this treatment has shown mild benefits in reducing blood pressure, particularly noticeable in patients with resistant hypertension. Furthermore, CPAP treatment appears to reduce cardiovascular events, both in primary and secondary prevention, though this benefit is limited to individuals with good compliance (CPAP use ≥4h/night). Future research perspectives in OSA seem to focus on identifying patients in whom the condition significantly influences cardiovascular risk, thus determining those who would benefit the most from treatment in the reduction of cardiovascular risk.</p></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":"36 4","pages":"Pages 234-242"},"PeriodicalIF":1.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139984147","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":"Sitosterolemia familiar: reporte de dos casos en Colombia","authors":"Alejandro A. Castellanos ,&nbsp;María del Carmen Castillo ,&nbsp;Laura Montoya ,&nbsp;María Elvira Ruiz ,&nbsp;Jorge L. Zapateiro ,&nbsp;Juan Patricio Nogueira","doi":"10.1016/j.arteri.2024.02.003","DOIUrl":"10.1016/j.arteri.2024.02.003","url":null,"abstract":"<div><p>Sitosterolemia is an autosomal recessive and very rare disease. Its main characteristic is that there is a greater absorption and a decrease in the excretion of sterols, which leads to them being deposited in tissues. It is given by mutations in the ABCG5 or ABCG8 genes found on chromosome 2p21. In this clinical note, we describe the first two patients with familial sitosterolemia described in Colombia, brothers, one of them with xanthomas in extremities as the only symptom, and the other, completely asymptomatic. Genetic studies were performed as a diagnostic test in both patients, where a pathogenic homozygous variant could be identified in the ABCG8 gene in the first case (symptomatic), and a heterozygous variant in the ABCG8 gene in the second case (asymptomatic); the first patient has responded to treatment with ezetimibe. In conclusion, xanthomas should be studied in depth in pediatric age as they may be the only visible sign of such complex and hereditary diseases as familial sitosterolemia, which can be controlled and prevent cardiovascular complications of the disease.</p></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":"36 4","pages":"Pages 229-233"},"PeriodicalIF":1.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040626","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":"Utilidad de la ecografía en el cribado del aneurisma de aorta abdominal en atención primaria","authors":"Antonio López-Téllez ,&nbsp;José Manuel Ramírez Torres ,&nbsp;Estrella Pérez Vázquez ,&nbsp;Miguel Ángel Babiano Fernández ,&nbsp;Helena López-Martí ,&nbsp;Irene Zapata Martínez ,&nbsp;Cristóbal Trillo Fernández ,&nbsp;Manuel Frías Vargas ,&nbsp;María Dolores Domínguez Pinos ,&nbsp;Juan Fernando Peiró Morant ,&nbsp;José Antonio González-Fajardo ,&nbsp;Pedro Valdivielso Felices","doi":"10.1016/j.arteri.2023.12.006","DOIUrl":"10.1016/j.arteri.2023.12.006","url":null,"abstract":"<div><h3>Introduction</h3><p>Abdominal aortic aneurysm (AAA) constitutes a pathology with high mortality. There is currently no screening program implemented in primary care in Spain.</p></div><div><h3>Objectives</h3><p>To evaluate the usefulness of ultrasound in the detection of AAA in the at-risk population in primary care. Secondarily, to identify subjects whose vascular risk (VR) should be reclassified and to determine whether AAA is associated with the presence of carotid plaque and other risk factors.</p></div><div><h3>Material and methods</h3><p>Cross-sectional, descriptive, multicenter, national, descriptive study in primary care.</p></div><div><h3>Subjects</h3><p>A consecutive selection of hypertensive males aged between 65 and 75 who are either smokers or former smokers, or individuals over the age of 50 of both sexes with a family history of AAA. Measurements: Diameter of abdominal aorta and iliac arteries; detection of abdominal aortic and carotid atherosclerotic plaque. VR was calculated at the beginning and after testing (SCORE).</p></div><div><h3>Results</h3><p>One hundred and fifty patients were analyzed (age: 68.3<!--> <!-->±<!--> <!-->5 years; 89.3% male). Baseline RV was high/very high in 55.3%. AAA was detected in 12 patients (8%; 95% <span>C</span>I: 4–12); aortic ectasia in 13 (8.7%); abdominal aortic plaque in 44% and carotid plaque in 62% of the participants. VR was reclassified in 50% of subjects. The detection of AAA or ectasia was associated with the presence of carotid plaque, current smoking and lipoprotein(a), <em>p</em> <!-->&lt;<!--> <!-->0.01.</p></div><div><h3>Conclusions</h3><p>The prevalence of AAA in patients with VR is high. Ultrasound in primary care allows detection of AAA and subclinical atherosclerosis and consequently reclassification of the VR, demonstrating its utility in screening for AAA in the at-risk population.</p></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":"36 4","pages":"Pages 218-226"},"PeriodicalIF":1.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139730642","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":"Riesgo trombótico asociado a COVID-19 y diabetes: ¿es PAI-1 el nexo?","authors":"José A. Páramo","doi":"10.1016/j.arteri.2024.06.001","DOIUrl":"10.1016/j.arteri.2024.06.001","url":null,"abstract":"","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":"36 4","pages":"Pages 227-228"},"PeriodicalIF":1.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471477","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":"Asociación de la placa de ateroma carotídea con los niveles plasmáticos de IL-18 y con polimorfismos en el gen del receptor de la IL-18 en la población mediterránea","authors":"Ana Palanca ,&nbsp;Amparo Bartual-Rodrigo ,&nbsp;Carolina Cuenca ,&nbsp;Oscar D. Mayo-López ,&nbsp;Francisco Javier Ampudia-Blasco ,&nbsp;Herminia González-Navarro ,&nbsp;Juan F. Ascaso ,&nbsp;Ana Bárbara García-García ,&nbsp;Felipe Javier Chaves ,&nbsp;José T. Real ,&nbsp;Sergio Martínez-Hervás","doi":"10.1016/j.arteri.2023.12.005","DOIUrl":"10.1016/j.arteri.2023.12.005","url":null,"abstract":"<div><h3>Background</h3><p>Atherosclerosis is an inflammatory disease. Interleukin 18 (IL-18) is an inflammatory molecule that has been linked to the development of atherosclerosis and cardiovascular disease.</p></div><div><h3>Objective</h3><p>To evaluate the possible relationship between plasma levels of IL-18 and the presence of atherosclerosis evaluated at the carotid level, as well as to analyze the possible modulation by different polymorphisms in a Mediterranean population.</p></div><div><h3>Material and methods</h3><p>Seven hundred and forty-six individuals from the metropolitan area of Valencia were included, recruited over a period of 2 years. Hydrocarbon and lipid metabolism parameters were determined using standard methodology and IL-18 using ELISA. In addition, carotid ultrasound was performed and the genotype of four SNPs related to the IL-18 signaling pathway was analyzed.</p></div><div><h3>Results</h3><p>Patients with higher plasma levels of IL-18 had other associated cardiovascular risk factors. Elevated IL-18 levels were significantly associated with higher carotid IMT and the presence of atheromatous plaques. The genotype with the A allele of the SNP rs2287037 was associated with a higher prevalence of carotid atheromatous plaque. On the contrary, the genotype with the C allele of the SNP rs2293224 was associated with a lower prevalence of atheromatous plaque.</p></div><div><h3>Conclusions</h3><p>High levels of IL-18 were significantly associated with a higher carotid IMT and the presence of atheromatous plaques, which appear to be influenced by genetic factors, as evidenced by associations between SNPs in the IL-18 receptor gene and the presence of atheroma plaque.</p></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":"36 4","pages":"Pages 210-217"},"PeriodicalIF":1.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433087","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":"Prof. Rafael Carmena Rodríguez","authors":"Juan F Ascaso","doi":"10.1016/j.arteri.2024.06.003","DOIUrl":"https://doi.org/10.1016/j.arteri.2024.06.003","url":null,"abstract":"","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":"36 4","pages":"Pages 267-268"},"PeriodicalIF":1.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0214916824000470/pdfft?md5=6630edd5e6f1ce1259d5d554e497d908&pid=1-s2.0-S0214916824000470-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141595882","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":"Thrombotic risk assessed by PAI-1 in patients with COVID-19: The influence of hyperglycemia and diabetes mellitus","authors":"Lourdes Basurto ,&nbsp;Leticia Manuel-Apolinar ,&nbsp;Ariadna Robledo ,&nbsp;Sean O’Leary ,&nbsp;Carlos Martínez-Murillo ,&nbsp;Lina Ivette Medina-Ortíz ,&nbsp;Mario German Montes Osorio ,&nbsp;Julio Zarazua ,&nbsp;Lourdes Balcázar-Hernández ,&nbsp;Juan Carlos Anda-Garay","doi":"10.1016/j.arteri.2023.12.004","DOIUrl":"10.1016/j.arteri.2023.12.004","url":null,"abstract":"<div><h3>Objective</h3><p>To assess thrombotic risk with PAI-1 levels in patients with COVID-19, to evaluate PAI-1 differences between hyperglycemic and/or Type 2 Diabetes Mellitus (T2DM) versus non-hyperglycemic patients, and to analyze the association of plasminogen activator inhibitor-1 (PAI-1) with hyperglycemia and T2DM.</p></div><div><h3>Methods</h3><p>A cross-sectional study carried out in 181 patients hospitalized for COVID-19. Two groups were formed: the patients with hyperglycemia at admission and/or previously diagnosed T2DM group and the non-hyperglycemic group. Fibrinolysis was assessed by measuring PAI-1 levels by ELISA.</p></div><div><h3>Results</h3><p>The mean age was 59.4<!--> <!-->±<!--> <!-->16.1 years; 55.8% were male 54.1% of patients presented obesity, 38.1% had pre-existing T2DM and 50.8% had admission hyperglycemia and/or pre-existing T2DM. The patients with admission hyperglycemia and/or preexisting T2DM had higher PAI-1 compared with non-hyperglycemic patients [197.5 (128.8–315.9) vs 158.1 (113.4–201.4) ng/mL; <em>p</em> <!-->=<!--> <!-->0.031]. The glucose levels showed a positive correlation with PAI-1 levels (<em>r</em> <!-->=<!--> <!-->0.284, <em>p</em> <!-->=<!--> <!-->0.041). A multivariate logistic regression analysis showed association of PAI-1 level and hyperglycemia and pre-existing T2DM with severity of COVID-19.</p></div><div><h3>Conclusion</h3><p>Patients hospitalized for COVID-19 infection with preexisting T2DM or hyperglycemia detected during their hospitalization presented a greater increase in PAI-1 levels, which suggests that hyperglycemia contributes directly to the hypercoagulable state and probably a worse outcome from the patients.</p></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":"36 4","pages":"Pages 201-209"},"PeriodicalIF":1.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0214916823001195/pdfft?md5=86b08e9724c54f8fed9aa1ddc260273c&pid=1-s2.0-S0214916823001195-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433090","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":"Consenso sobre lipoproteína (a) de la Sociedad Española de Arteriosclerosis. Revisión bibliográfica y recomendaciones para la práctica clínica","authors":"Javier Delgado-Lista ,&nbsp;Jose M. Mostaza ,&nbsp;Teresa Arrobas-Velilla ,&nbsp;Francisco Blanco-Vaca ,&nbsp;Luis Masana ,&nbsp;Juan Pedro-Botet ,&nbsp;Pablo Perez-Martinez ,&nbsp;Fernando Civeira ,&nbsp;Jose I. Cuende-Melero ,&nbsp;Jose J. Gomez-Barrado ,&nbsp;Carlos Lahoz ,&nbsp;Xavier Pintó ,&nbsp;Manuel Suarez-Tembra ,&nbsp;Jose Lopez-Miranda ,&nbsp;Carlos Guijarro","doi":"10.1016/j.arteri.2024.03.002","DOIUrl":"10.1016/j.arteri.2024.03.002","url":null,"abstract":"<div><p>The irruption of lipoprotein(a) (Lp(a)) in the study of cardiovascular risk factors is perhaps, together with the discovery and use of proprotein convertase subtilisin/kexin type 9 (iPCSK9) inhibitor drugs, the greatest novelty in the field for decades. Lp(a) concentration (especially very high levels) has an undeniable association with certain cardiovascular complications, such as atherosclerotic vascular disease (AVD) and aortic stenosis. However, there are several current limitations to both establishing epidemiological associations and specific pharmacological treatment. Firstly, the measurement of Lp(a) is highly dependent on the test used, mainly because of the characteristics of the molecule. Secondly, Lp(a) concentration is more than 80% genetically determined, so that, unlike other cardiovascular risk factors, it cannot be regulated by lifestyle changes. Finally, although there are many promising clinical trials with specific drugs to reduce Lp(a), currently only iPCSK9 (limited for use because of its cost) significantly reduces Lp(a).</p><p>However, and in line with other scientific societies, the SEA considers that, with the aim of increasing knowledge about the contribution of Lp(a) to cardiovascular risk, it is relevant to produce a document containing the current status of the subject, recommendations for the control of global cardiovascular risk in people with elevated Lp(a) and recommendations on the therapeutic approach to patients with elevated Lp(a).</p></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":"36 4","pages":"Pages 243-266"},"PeriodicalIF":1.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0214916824000238/pdfft?md5=76435180d7cbcd8d281b2b14c374f51e&pid=1-s2.0-S0214916824000238-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860901","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":"Análisis clínico-epidemiológico de pacientes con lipoproteína(a) elevada en un hospital de tercer nivel","authors":"Manuel García de Prada ,&nbsp;Ramón Costa Segovia ,&nbsp;Marta de Castro Martínez ,&nbsp;Nuria Valdeolivas Hidalgo ,&nbsp;María Belén Sánchez López ,&nbsp;Agustín Blanco Echevarría","doi":"10.1016/j.arteri.2023.12.001","DOIUrl":"10.1016/j.arteri.2023.12.001","url":null,"abstract":"<div><h3>Objective</h3><p>The objective of the study is to describe the clinical and epidemiological characteristics of our patients with elevated Lp(a).</p></div><div><h3>Materials and methods</h3><p>A descriptive cross-sectional study was conducted on 316 patients with elevated Lp(a) (&gt;125 nmol/L) in a random sample between January and August 2022. We measured epidemiological, anthropometric, clinical and laboratory variables (lipid metabolism parameters, carbohydrates and hormones).</p></div><div><h3>Results</h3><p>Mean age of our sample subject's was 59 ± 15 years with 56% males. The average BMI was 27.6 kg/m2 (71% with elevated BMI). Elevated waist circumference was observed in 54.1% of men and 77.8% of women. 48% had hypertension, 30.7% had diabetes mellitus and 91.5% dyslipidemia. Only 39.7% of the patients had never smoked.</p><p>The mean values of total cholesterol were 158 ± 45 mg/dl, LDL was 81 ± 39 mg/dl, HDL was 53 ± 17 mg/dl, Triglycerides were 127 ± 61 mg/dl, and Lp(a) was 260 ± 129 nmol/L.</p><p>Regarding lipid lowering treatment, 89% were on statins, 68.6% on ezetimibe, and 13.7% on PCSK9 inhibitors. 177 patients (57,7%) had established cardiovascular disease (CVD), 16.3% had polyvascular disease, 11.7% had subclinical CVD, and 30.6% had no known CVD. Among patients with established CVD, 174 (98.3%) were on lipid-lowering treatment (97.2% on statins) and 86.4% were on antiplatelet therapy. The mean age of cardiovascular events was 55 ± 12 years in males and 60 ± 11 years in females. 65,1% of female and 56,2% of male patients suffered an early cardiovascular event.</p></div><div><h3>Conclusions</h3><p>Patients with elevated Lp(a) are at very high cardiovascular risk, particularly for early cardiovascular disease.</p></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":"36 3","pages":"Pages 118-125"},"PeriodicalIF":1.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139075393","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}