Blood Transfusion最新文献

{"title":"Development and evaluation of trigger tools to identify pediatric blood management errors.","authors":"Swaminathan Kandaswamy, Cassandra D Josephson, Margo R Rollins, Jennifer Jones, Patricia Zerra, Ruchika Goel, Jennifer Andrews, Jeanne E Hendrickson, Lani Lieberman, Evan W Orenstein","doi":"10.2450/BloodTransfus.606","DOIUrl":"10.2450/BloodTransfus.606","url":null,"abstract":"<p><strong>Background: </strong>Pediatric Patient Blood Management (PBM) programs require continuous surveillance of errors and near misses. However, most PBM programs rely on passive surveillance methods. Our objective was to develop and evaluate a set of automated trigger tools for active surveillance of pediatric PBM errors.</p><p><strong>Materials and methods: </strong>We used the Rand-UCLA method with an expert panel of pediatric transfusion medicine specialists to identify and prioritize candidate trigger tools for all transfused blood products. We then iteratively developed automated queries of electronic health record (EHR) data for the highest priority triggers. Two physicians manually reviewed a subset of cases meeting trigger tool criteria and estimated each trigger tool's positive predictive value (PPV). We then estimated the rate of PBM errors, whether they reached the patient, and adverse events for each trigger tool across four years in a single pediatric health system.</p><p><strong>Results: </strong>We identified 28 potential triggers for pediatric PBM errors and developed 5 automated trigger tools (positive patient identification, missing irradiation, unwashed products despite prior anaphylaxis, transfusion lasting >4 hours, over-transfusion by volume). The PPV for ordering errors ranged from 38-100%. The most frequently detected near miss event reaching patients was first transfusions without positive patient identification (estimate 303, 95% CI: 288-318 per year). The only adverse events detected were from over-transfusions by volume, including 4 adverse events detected on manual review that had not been reported in passive surveillance systems.</p><p><strong>Discussion: </strong>It is feasible to automatically detect pediatric PBM errors using existing data captured in the EHR that enable active surveillance systems. Over-transfusions may be one of the most frequent causes of harm in the pediatric environment.</p>","PeriodicalId":49260,"journal":{"name":"Blood Transfusion","volume":" ","pages":"484-491"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337447","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":"Genomic characterization of clinically significant blood group variants in Aboriginal Australians.","authors":"Sudhir Jadhao, Candice Davison, Eileen Roulis, Simon Lee, Tamika Campbell, Reece Griffin, Maree Toombs, Alex Brown, Maree Perry, Bushra Nasir, David O Irving, Catherine A Hyland, Robert L Flower, Shivashankar H Nagaraj","doi":"10.2450/BloodTransfus.664","DOIUrl":"10.2450/BloodTransfus.664","url":null,"abstract":"<p><strong>Background: </strong>Hematological disorders are often treated with blood transfusions. Many blood group antigens and variants are population-specific, and for patients with rare blood types, extensive donor screening is required to find suitable matches for transfusion. There is a scarcity of knowledge regarding blood group variants in Aboriginal Australian populations, despite a higher need for transfusion due to the higher prevalence of renal diseases and anemia.</p><p><strong>Materials and methods: </strong>In this study, we applied next-generation sequencing and analysis to 245 samples obtained from Aboriginal Australians from South-East Queensland, to predict antigen phenotypes for 36 blood group systems.</p><p><strong>Results: </strong>We report potential weak antigens in blood group systems RH, FY and JR that have potential clinical implications in transfusion and pregnancy settings. These include partial DIII type 4, weak D type 33, and Del RHD (IVS2-2delA). The rare Rh phenotypes D+ C+ E+ c- e+ and D+ C+ E+ c+ e- were also detected.</p><p><strong>Discussion: </strong>The comprehensive analyses of blood group genetic variant profiles identified in this study will provide insight and an opportunity to improve Aboriginal health by aiding in the identification of appropriate blood products for population-specific transfusion needs.</p>","PeriodicalId":49260,"journal":{"name":"Blood Transfusion","volume":" ","pages":"464-474"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337448","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":"Implementing Patient Blood Management in major digestive surgery: should we do more?","authors":"Marco Catarci","doi":"10.2450/BloodTransfus.828","DOIUrl":"10.2450/BloodTransfus.828","url":null,"abstract":"","PeriodicalId":49260,"journal":{"name":"Blood Transfusion","volume":" ","pages":"551-552"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972196","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":"The new SoHO Regulation. What should the blood system expect?","authors":"Simonetta Pupella","doi":"10.2450/BloodTransfus.889","DOIUrl":"10.2450/BloodTransfus.889","url":null,"abstract":"","PeriodicalId":49260,"journal":{"name":"Blood Transfusion","volume":" ","pages":"461-463"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511375","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":"Evaluation of platelet function by Total Thrombus-Formation Analysis System (T-TAS^®01) in term and preterm infants and its relationship with patent ductus arteriosus. A prospective observational pilot study.","authors":"Ester Capecchi, Valeria Cortesi, Genny Raffaeli, Irene Picciolli, Nicola Pesenti, Monica Fumagalli, Giacomo Cavallaro, Stefano Ghirardello, Gaia Francescato","doi":"10.2450/BloodTransfus.765","DOIUrl":"https://doi.org/10.2450/BloodTransfus.765","url":null,"abstract":"<p><strong>Background: </strong>Newborns exhibit a pro-coagulant hemostatic profile despite platelet hyporeactivity and reduced coagulation factors. Assessing infant hemostasis, particularly in preterm infants, is challenging, with inconsistent findings regarding the relationship between platelet count and function in patients with patent ductus arteriosus (PDA).</p><p><strong>Materials and methods: </strong>This study aims to assess platelet function using the Total Thrombus-Formation Analysis System (T-TAS^®01) in term and preterm newborns. T-TAS^®01 measures the Occlusion Start Time (OST), Occlusion Time (OT), and the Area Under the Curve (AUC) at the end of thrombus formation. The study includes term and preterm newborns below 30 weeks' gestational age (GA) admitted to the Neonatal Intensive Care Unit. Blood samples were collected from preterm newborns on the 1^st day of life (T0), between 48-72 hours of life (T1), between the 7^th and 10^th day of life (T2), and from term newborns at T0 and T2. Secondary endpoints include the relationship between T-TAS^®01 parameters and significant PDA in preterm newborns and the correlation between T-TAS^®01 parameters, GA, and complete blood count (CBC).</p><p><strong>Results: </strong>OST is delayed by 65.5 seconds in preterm infants at T0 (p<0.001) and by 46 seconds at T2 (p=0.041) compared to full-term newborns. OT is delayed by 164 seconds in preterm infants at T0 (p=0.002) and by 352 seconds at T2 (p=0.002). AUC at T0 is lower in preterm infants (p=0.028). There is no significant correlation between T-TAS^®01 parameters and GA or CBC. Additionally, OST and OT are delayed, and AUC is reduced in preterm infants with PDA and hemodynamically significant PDA (hsPDA).</p><p><strong>Discussion: </strong>T-TAS^®01 is a reliable tool for evaluating platelet function in term newborns. However, measurements show higher variability in preterm infants, with significantly lower platelet activity observed in preterm infants with PDA and hsPDA.</p>","PeriodicalId":49260,"journal":{"name":"Blood Transfusion","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773757","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":"Patient Blood Management in 2023: a Nationwide Survey of Anesthesiologists in Romania following the 2018 Guidelines.","authors":"Daniela Filipescu, Mihai-Gabriel Ştefan, Şerban Ion Bubenek Turconi, Dan Corneci, Gabriela Droc, Raluca Goicea, Ioana Grigoraş, Ioana M Grinţescu, Liliana Mirea, Cornelia Predoi, Anca-Irina Ristescu, Silvius Negoiţă, Dorel Săndesc, Ecaterina Scărlătescu, Liana Văleanu, Ştefan Andrei, Dana Tomescu","doi":"10.2450/BloodTransfus.776","DOIUrl":"https://doi.org/10.2450/BloodTransfus.776","url":null,"abstract":"<p><strong>Background: </strong>In 2018, Romania established national guidelines for patient blood management (PBM), endorsed by the Romanian Society of Anesthesia and Intensive Care (SRATI) and approved by the Ministry of Health. These guidelines emphasize managing anemia, coagulation issues, and the cautious use of allogeneic transfusions to improve patient outcomes.</p><p><strong>Materials and methods: </strong>A national survey was conducted among Romanian anesthesiologists to assess PBM guideline adoption. It included 38 questions addressing PBM strategies, resources, transfusion practices, and barriers to implementation. The survey was distributed via email to the SRATI database.</p><p><strong>Results: </strong>Out of 512 professionals who opened the survey, 74% had adopted some PBM measures, and 97% recognized PBM's efficacy in improving outcomes. However, only 33% of anesthesiologists worked in hospitals with formal PBM groups, and 39% had attended PBM-related educational events. Preoperative anemia management was inconsistent, with only 33.5% routinely treating anemia. Access to diagnostic and therapeutic tools was limited; transferrin saturation testing was available in 27% of cases, and erythropoietin was used in 24%. Despite these limitations, 72% of respondents treated anemia with intravenous iron. The main challenges to implementation included insufficient time for pre-surgical assessments, lack of standardized procedures, and difficulties in surgeon-anesthetist collaboration.</p><p><strong>Discussion: </strong>The survey highlights the need for systemic improvements in PBM adoption. Recommendations include enhancing organizational structures, standardizing protocols, and improving interdisciplinary collaboration to boost PBM implementation in Romania. While progress has been made, a national program with dedicated funding and auditing could facilitate widespread PBM integration into clinical practice.</p>","PeriodicalId":49260,"journal":{"name":"Blood Transfusion","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511372","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":"Genetic and mechanistic evaluation of an individual with para-Bombay phenotype associated with a compound heterozygote comprising two novel FUT1 variants.","authors":"Yanling Ying, Xiaozhen Hong, Jingjing Zhang, Kairong Ma, Xianguo Xu, Faming Zhu","doi":"10.2450/BloodTransfus.505","DOIUrl":"10.2450/BloodTransfus.505","url":null,"abstract":"<p><strong>Background: </strong>As is well documented, the para-Bombay phenotype is typically characterized by the reduction or absence of ABH antigens on red blood cells but the presence of corresponding antigens in saliva. Herein, the underlying molecular mechanism of an individual with para-Bombay AB phenotype combined with two novel variants of the FUT1 gene was investigated.</p><p><strong>Materials and methods: </strong>ABH antigens and antibodies were detected in the serum of the proband using conventional serological methods. The coding region nucleotides of the ABO, FUT1, and FUT2 genes were directly sequenced by polymerase chain reaction. Moreover, the FUT1 haploid type in the proband was analyzed by TA clone sequencing. The 3D structure of wild-type and mutant fucosyltransferases were simulated and analyzed using Phyre2 and Pymol software. Lastly, the effect of missense substitution on the function of fucosyltransferase was predicted by the Polymorphism Phenotyping algorithm (PolyPhen-2) and MutationTaster.</p><p><strong>Results: </strong>ABH antigens were noted to be absent on the surface of red blood cells of the proband. The ABO genotype was ABO*A1.02/ABO*B.01, while the FUT2 genotype was FUT2*01/FUT2*c.357T. Interestingly, two novel missense variants (c.289G>A, p.Ala97Thr and c.575G>C, p.Arg192Pro) and one synonymous SNP (c.840G>A) were identified in the FUT1 gene. Furthermore, c.289G>A was detected in one haploid type, whereas c.575G>C and c.840G>A were discovered in another haploid type. Meanwhile, in silico analysis revealed that amino acid substitution caused by missense variants altered the partial spatial structure of the α-helices where residues 97 and 298 were located using 3D homology modeling software. Finally, both missense variants were defined as probably damaging based on PolyPhen-2 prediction.</p><p><strong>Discussion: </strong>Two novel FUT1 variants were identified in a Chinese individual with para-Bombay AB phenotype, which can expand our understanding of the molecular mechanism underlying the para-Bombay phenotype and contribute to improving the safety of blood transfusion.</p>","PeriodicalId":49260,"journal":{"name":"Blood Transfusion","volume":" ","pages":"369-376"},"PeriodicalIF":2.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11390608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9881543","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":"First investigation of RH gene polymorphism in patients with sickle cell disease and associated blood donors in Cameroon, Central Africa.","authors":"Jeanne Manga Messina Mbeti, Caroline Bénech, Françoise Ngo Sack, Estelle Wete, Hortense Ngegni Pangetha, Simon Noël Ateba, Jules Tchatchueng, Alexandre Njan Nloga, Yann Fichou","doi":"10.2450/BloodTransfus.660","DOIUrl":"10.2450/BloodTransfus.660","url":null,"abstract":"<p><strong>Background: </strong>Although genetic polymorphism of the RH blood group system is well known in sub-Saharan Africa, national/regional specificities still remain to be described precisely. For the first time in Cameroon, Central Africa, and in order to better characterize the molecular basis driving RH phenotype variability, as well as to identify the main antigens that may be potentially responsible for alloimmunization, we sought 1) to study the RH genes in a cohort of 109 patients with sickle cell disease; 2) to study the same genes in the corresponding donors whose red blood cells (RBCs) were transfused to the patients (108 donors in 98 patients); 3) to predict RH phenotype on the basis of the molecular data and compare the results with serologic testing; and 4) to identify retrospectively patients at risk for alloimmunization.</p><p><strong>Materials and methods: </strong>In order to generate an exhaustive dataset, the RH genes of all patient and donor samples were systematically investigated 1) by quantitative multiplex PCR of short fluorescent fragments (QMPSF) for characterization of RHD gene zygosity and potential structural variants (SVs), and 2) by Sanger sequencing for identification of single nucleotide variants (SNVs). Subsequent to molecular analysis, the genotypes and RH phenotype were deduced and predicted, respectively, from reference databases.</p><p><strong>Results: </strong>In a total of 217 Cameroonian individuals, as many as 24 and up to 22 variant alleles were identified in the RHD and RHCE genes, respectively, in addition to the reference alleles. Interestingly, 65 patients with SCD (66.3%) were assumed to be exposed to one or more undesirable RH antigen(s) with varying degrees of clinical relevance.</p><p><strong>Discussion: </strong>Beyond the comprehensive report of the nature and distribution of RH variant alleles in a subset of Cameroonian patients treated by transfusion therapy, this work highlights the need for an extensive review of current practice, including routine serologic typing procedures, preferably in the near future.</p>","PeriodicalId":49260,"journal":{"name":"Blood Transfusion","volume":" ","pages":"377-386"},"PeriodicalIF":2.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11390615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139693362","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":"Navigating anemia and anticoagulation in elderly patients undergoing orthopedic surgery: strategies for preventing complications and implementing treatments.","authors":"Elvira Grandone, Giovanni L Tiscia, Angelo Ostuni, Francesco Marongiu, Doris Barcellona","doi":"10.2450/BloodTransfus.640","DOIUrl":"10.2450/BloodTransfus.640","url":null,"abstract":"<p><strong>Background: </strong>Elderly populations face an increased risk of anemia, leading to elevated transfusion requirements during surgery, especially major orthopedic procedures. Anemia itself increases the risk of thromboembolic events, thus compounding complications in elderly individuals. Polypharmacy and the prevalent use of oral anticoagulants (OAC), particularly for atrial fibrillation, contribute to bleeding risks in this population. Data available in the literature on the peri-operative management of anemia in patients taking OAC is limited and often heterogeneous.</p><p><strong>Materials and methods: </strong>This narrative case-based review focuses on the peri-operative management of elderly patients on OAC undergoing major orthopedic surgery. PubMed/Medline was used to search for relevant literature.</p><p><strong>Results: </strong>With reference to two cases, we critically evaluate the literature, and focus on risk factors, and preventive and therapeutic strategies as fundamental tools to reduce bleeding and correct anemia as soon as possible in elderly patients undergoing major orthopedic surgery.</p><p><strong>Discussion: </strong>Peri-operative management of these patients, especially those on OAC, requires a balanced approach considering bleeding and thrombotic risks. Intravenous iron therapy and tranexamic acid emerge as valuable strategies in minimizing transfusion requirements and optimizing patients' outcomes.</p>","PeriodicalId":49260,"journal":{"name":"Blood Transfusion","volume":" ","pages":"450-458"},"PeriodicalIF":2.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11390616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141179901","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 systematic review of indications when and how a military walking blood bank could bridge blood product unavailability.","authors":"Julie Degueldre, Emilie Dessy, France T'Sas, Véronique Deneys","doi":"10.2450/BloodTransfus.603","DOIUrl":"10.2450/BloodTransfus.603","url":null,"abstract":"<p><strong>Background: </strong>Blood supply problems in remote areas are well known. To overcome this shortage, many countries have developed innovative walking blood bank (WBB) protocols. However, no common standards have yet been set for their use and common actions. Given that these procedures involve a certain risk, it would be interesting to analyse the activating criteria that lead to using this unusual protocol. Thus, this review aimed to identify indications for a WBB and the common risk mitigation measures.</p><p><strong>Material and methods: </strong>This PRISMA-compliant review only included studies published from 1985 to 25^th of January 2023 that describe adult male military casualties requiring blood transfused locally using a walking blood transfusion protocol. All relevant data (i.e., activation and contextual factors and risk mitigation measures) were tabulated to retrieve information from the selected military studies.</p><p><strong>Results: </strong>Our results indicated that activation criteria were homogeneous across the 12 reviewed studies. Whole blood was collected from a WBB when there was a shortage of blood products and when platelets were needed. In the literature reviewed, the main risks associated with such a protocol, namely hemolytic adverse events and transfusion transmitted diseases, are mitigated by the use of typing and screening measures if they are reported. However, there is less consistency in the implementation of those risk mitigation measures.</p><p><strong>Discussion: </strong>This unusual protocol needs to be integrated into the medical support plan until conventional transfusion support can take over, and should include on-site blood collection from a donor, whether a WBB or an emergency donor panel. The benefits of such a protocol outweigh the risks in a life-threatening situation, especially since these risks can be anticipated and minimised by planning to pre-screen all potential donors before their deployment. Finally, educating and training the staff who must implement this unusual procedure can also improve the safety and survival rate of future patients.</p>","PeriodicalId":49260,"journal":{"name":"Blood Transfusion","volume":" ","pages":"395-404"},"PeriodicalIF":2.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11390613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139693360","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}