Pediatric Rheumatology最新文献

{"title":"Treatment after intra-articular corticosteroid injection in juvenile idiopathic arthritis: a survey within the German Society for Pediatric and Adolescent Rheumatology.","authors":"Sophia Meister, Mathias Georgi, Boris Hügle, Johannes-Peter Haas","doi":"10.1186/s12969-025-01156-6","DOIUrl":"10.1186/s12969-025-01156-6","url":null,"abstract":"","PeriodicalId":54630,"journal":{"name":"Pediatric Rheumatology","volume":"23 1","pages":"96"},"PeriodicalIF":2.3,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214139","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":"Serum elafin levels in patients with IgA vasculitis: a prospective case-control study.","authors":"Cengiz Zeybek, Ahmet Bolat, Bedriye Nuray Alpman, Tuğba İpek Karaoğlu, Nimet Öner, Vildan Güngörer","doi":"10.1186/s12969-025-01153-9","DOIUrl":"10.1186/s12969-025-01153-9","url":null,"abstract":"<p><strong>Objectives: </strong>Immunoglobulin A vasculitis (IgAV) is a small-vessel vasculitis characterized by perivascular IgA deposition and neutrophil activation. Elafin, an anti-inflammatory and anti-protease protein expressed by epithelial and select immune cells, may play a role in modulating vascular inflammation. We evaluated serum elafin levels in pediatric patients with IgAV during active stage and remission, and investigated their associations with disease activity, organ involvement, and systemic inflammatory markers.</p><p><strong>Methods: </strong>This single-center prospective case-control study included 51 pediatric patients diagnosed with IgAV and 54 age- and sex-matched healthy controls. Paired data were obtained from the same IgAV patients during the remission phase, allowing intra-individual comparisons. Serum elafin levels were quantified using enzyme-linked immunosorbent assay (ELISA). Inflammatory parameters, including complete blood counts, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), were assessed in all participants.</p><p><strong>Results: </strong>Serum elafin levels were significantly elevated in patients with IgAV (45.43 ± 11.11 ng/dL; range: 34.02-69.28) compared to healthy controls (27.44 ± 12.66 ng/dL; range: 0.01-41.84) (p < 0.001), with the highest concentrations observed during active disease stage (p < 0.001). Patients with visceral involvement (gastrointestinal, renal, or scrotal) exhibited significantly higher elafin levels (p < 0.05), whereas no significant association was found with isolated skin or joint involvement. Serum elafin levels demonstrated positive correlations with the ESR (p = 0.001, r = 0.418), CRP (p < 0.001, r = 0.547), neutrophil-to-lymphocyte ratio (p = 0.002, r = 0.355), and systemic immune-inflammation index (p = 0.003, r = 0.347). Receiver operating characteristic curve analysis identified an optimal serum elafin cut-off value of 35.38 ng/dL for distinguishing active IgAV, yielding a sensitivity of 86.2% and specificity of 77.8%.</p><p><strong>Conclusion: </strong>Serum elafin levels were significantly elevated during the active stage of IgAV and may serve as a potential biomarker for disease activity, particularly in patients with visceral involvement.</p>","PeriodicalId":54630,"journal":{"name":"Pediatric Rheumatology","volume":"23 1","pages":"95"},"PeriodicalIF":2.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193836","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":"Childhood-onset Takayasu arteritis: clinical presentation, challenges and disease course.","authors":"L Peremans, M Twilt, A Fifi-Mah, N Johnson, D Mosher, A Wade, L Hamiwka","doi":"10.1186/s12969-025-01147-7","DOIUrl":"10.1186/s12969-025-01147-7","url":null,"abstract":"<p><strong>Background: </strong>Takayasu arteritis (TAK) is a rare granulomatous inflammatory vasculitis primarily affecting the aorta and its major branches. Data on childhood-onset TAK (c-TAK) remain scarce. This study retrospectively evaluates the clinical presentation, disease flares, treatment, and outcomes of c-TAK in a tertiary Canadian center.</p><p><strong>Methods: </strong>We identified all children under 18 years of age at disease onset with a clinical diagnosis of TAK seen at Alberta Children's Hospital, Calgary, Canada, between 2000 and 2024. Patients meeting the EULAR/PRINTO/Pres classification criteria for c-TAK were included. Baseline demographic data, clinical presentation, laboratory findings, imaging results, disease flares, and treatment were documented. Additionally, we highlight two challenging cases due to their particularly complex disease trajectories.</p><p><strong>Results: </strong>Six children (4 female) with a median age at diagnosis of 14.5 years (range: 4-17) met the classification criteria for c-TAK. Clinical presentation was variable, with the most common symptoms being fatigue (n = 4), weight loss (n = 3), and hypertension (n = 3). The most frequently affected arteries were the abdominal aorta and carotid arteries (n = 5) followed by ascending aorta (n = 4). All patients received corticosteroids for induction treatment. Additional immunosuppressive therapies included methotrexate (n = 5), infliximab (n = 2), tocilizumab (n = 2), IVIG (n = 2), etanercept (n = 1), adalimumab (n = 1), and cyclophosphamide (n = 1).</p><p><strong>Conclusions: </strong>TAK is a rare, potentially life-threatening large-vessel vasculitis. Early recognition is crucial for timely diagnosis and aggressive treatment initiation. Children with TAK often experience a complex disease course requiring multiple treatment adjustments and surgical or endovascular interventions. Large, multinational collaborations are essential for advancing our knowledge and improving patient outcomes.</p>","PeriodicalId":54630,"journal":{"name":"Pediatric Rheumatology","volume":"23 1","pages":"94"},"PeriodicalIF":2.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193859","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":"Children's experiences of a support program during their first year with juvenile idiopathic arthritis : - Insights from qualitative interviews.","authors":"Karina Mördrup, Cecilia Bartholdson, Eva Broström, Johanna Granhagen Jungner","doi":"10.1186/s12969-025-01142-y","DOIUrl":"10.1186/s12969-025-01142-y","url":null,"abstract":"<p><strong>Background: </strong>Research reveals that both children and parents often experience fear and anxiety upon being diagnosed with a chronic disease like juvenile idiopathic arthritis. A one-year juvenile arthritis support program (JASP-1) has been developed to offer patient- and family-centered support and education to empower children and their parents in their new situation. However, there is limited knowledge about children's experiences of participating in such support programs. Therefore, this study aimed to describe children's experiences of participating in JASP-1 during their first year with juvenile idiopathic arthritis.</p><p><strong>Methods: </strong>Data were collected using individual semi-structured interviews with children who had participated in JASP-1. The interviews were transcribed and analyzed using qualitative content analysis.</p><p><strong>Results: </strong>Fourteen children between 12 and 17 years of age, with a mean age of 14 years, were interviewed. Three distinct categories were identified. The children reported that their involvement in JASP-1 provided them with a sense of security through treatment, a sense of security through information and support; and that contact, visits, and school presence were in balance.</p><p><strong>Conclusion: </strong>The results showed that JASP-1 successfully integrated contact through phone calls, visits, and medical and psychosocial support in a satisfactory and accessible way for children recently diagnosed with JIA. This provided them with a comprehensive sense of security. Our findings indicate that patient- and family-centered programs like JASP-1 not only have the potential to enhance and standardize care for children newly diagnosed with JIA but also to contribute to improved and equitable healthcare outcomes in the future.</p>","PeriodicalId":54630,"journal":{"name":"Pediatric Rheumatology","volume":"23 1","pages":"92"},"PeriodicalIF":2.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076679","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":"Proceedings of the 32nd European Paediatric Rheumatology Congress.","authors":"","doi":"10.1186/s12969-025-01138-8","DOIUrl":"10.1186/s12969-025-01138-8","url":null,"abstract":"","PeriodicalId":54630,"journal":{"name":"Pediatric Rheumatology","volume":"23 Suppl 2","pages":"93"},"PeriodicalIF":2.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076151","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":"Evaluating the causal effect of circulating proteome on the risk of Juvenile idiopathic arthritis: an omics pipeline study.","authors":"Xinglin Wu, Qiang Luo, Xiwen Luo, Dawei Liu, Fengming Li, Chenxi Ma, Xuemei Tang","doi":"10.1186/s12969-025-01140-0","DOIUrl":"10.1186/s12969-025-01140-0","url":null,"abstract":"<p><strong>Background: </strong>Genome-wide association studies (GWAS) have pinpointed a multitude of risk loci associated with Juvenile Idiopathic Arthritis (JIA), but it is challenging to decipher novel plasma proteins. To address this, we applied an integrative omics pipeline to uncover novel proteins associated with JIA risk.</p><p><strong>Methods: </strong>In this research, we utilized an integrative omics method to identify new plasma proteins associated with JIA. Complementary results from an independent cohort were analyzed through Whole Genome Sequencing (WGS), single-cell RNA sequencing (scRNA-seq), and bulk RNA sequencing (bulk RNA-seq) at the Children's Hospital of Chongqing Medical University to validate the reliability of the identified novel proteins. Additionally, to assess the therapeutic potential of novel proteins, we performed Phe-WAS and conducted an extensive review of existing literature using PubMed and Web of Science.</p><p><strong>Results: </strong>An integrative omics pipeline analysis identified ERAP2 as having putatively causal effects on JIA. In the fourth step of Summary-data-based Mendelian randomization analysis, we discovered that the SNP rs2927608 and rs2910686 can regulate the expression of the ERAP2 gene, thereby regulating the protein content of both ERAP2 and ERAP1. WGS analysis also detected two potentially pathogenic mutations on ERAP2 in sJIA patients. ScRNA-seq reveals that ERAP2 expression is significantly elevated in patients with sJIA compared to normal and other subtypes, particularly in monocytes. Bulk RNA-seq with ROC analysis demonstrating significant diagnostic power (AUC = 0.86, 95%CI: 0.71-1.00) in discriminating sJIA from healthy controls. Literature and Phe-WAS search revealed that ERAP2 is primarily studied in the context of genetic predisposition to disease and is closely related to autoimmune disorders.</p><p><strong>Conclusions: </strong>ERAP2 was identified as a candidate associated with JIA, especially sJIA, through integrative omics analysis, indicating its potential role in protein-mediated disease mechanisms and therapeutic targeting.</p>","PeriodicalId":54630,"journal":{"name":"Pediatric Rheumatology","volume":"23 1","pages":"91"},"PeriodicalIF":2.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979130","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 roadmap for navigating child health research data sharing across Canada and beyond - building on UCAN CAN-DU.","authors":"Brittany Gerber, Gillian R Currie, Alexander Mosoiu, Alexander Bernier, Francois P Bernier, Kym M Boycott, Guillermo Fiebelkorn, Kristien Hens, Bartha M Knoppers, Claire LeBlanc, Stephen W Scherer, David Shaw, Chris Viney, Carl Virtanen, Susanne M Benseler, Rae S M Yeung, Deborah A Marshall","doi":"10.1186/s12969-025-01139-7","DOIUrl":"10.1186/s12969-025-01139-7","url":null,"abstract":"","PeriodicalId":54630,"journal":{"name":"Pediatric Rheumatology","volume":"23 1","pages":"89"},"PeriodicalIF":2.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12403251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979096","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":"Neurological involvement in children with familial Mediterranean fever: a systematic review.","authors":"Saverio La Bella, Antonio Corsello, Deniz Bayraktar, Armando Di Ludovico, Giovanna Scorrano, Marta Rinaldi, Yagmur Bayindir, Seza Ozen, Gregorio Paolo Milani, Marco Gattorno, Roberta Caorsi","doi":"10.1186/s12969-025-01137-9","DOIUrl":"10.1186/s12969-025-01137-9","url":null,"abstract":"<p><strong>Background: </strong>Although typical findings of familial Mediterranean fever (FMF), such as brief fever episodes and abdominal or chest pain, have been largely described, little is known about the neurological manifestations of the disease in childhood.</p><p><strong>Methods: </strong>A systematic search of the literature was conducted in PubMed/Medline, Cochrane, and Web of Science databases in accordance with the PRISMA guidelines, using MeSH terms related to FMF and neurological manifestations. Studies involving patients under 18 years of age diagnosed with FMF with neurological manifestations were included.</p><p><strong>Results: </strong>Sixty-four studies, comprising 4753 children with FMF, were included. Approximately 33.9% of them had some degree of neurological involvement. Headache was the most common neurological symptom and was often associated with FMF flares, with frequencies ranging from 4.8 to 58.8%. Febrile seizures were also relevant manifestations, as expected in children with FMF since they have more and more high fever during childhood, with frequencies ranging from 1 to 15.2%. Demyelinating disorders, such as multiple sclerosis, were rarely reported, mostly in female adolescents with the homozygous M694V MEFV genotype. A few studies have shown that cochlear and retinal involvement due to chronic and recurrent inflammation may contribute to sensorineural hearing loss and retinal abnormalities.</p><p><strong>Conclusion: </strong>Although causality has not been shown and reporting bias cannot be excluded, neurological involvement appears relatively common in children with FMF and may lead to long-term disability and reduced quality of life. These findings support the need for a comprehensive neurological assessment to enable early detection, appropriate management, and better long-term outcomes.</p>","PeriodicalId":54630,"journal":{"name":"Pediatric Rheumatology","volume":"23 1","pages":"90"},"PeriodicalIF":2.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12403484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979085","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":"Myocardial dysfunction is linked to endothelial dysfunction in JIA patients: a study of novel aortic circumferential strain.","authors":"Eman Shafik Shafie, Fatma ElZahraa Mostafa, Mohamad Samir AbdelWanis, Mira M Gales, Antoine Fakhry AbdelMassih, Rana Essam","doi":"10.1186/s12969-025-01073-8","DOIUrl":"https://doi.org/10.1186/s12969-025-01073-8","url":null,"abstract":"<p><strong>Background: </strong>Accelerated vascular stiffness and myocardial dysfunction in juvenile idiopathic arthritis have been established. However, the relationship between these two conditions remains under investigated in the literature. The aim of this study was to determine whether there is any correlation between the extent of vascular and myocardial involvement in JIA patients.</p><p><strong>Methodology: </strong>For this purpose, 22 JIA patients and an equivalent number of controls were investigated by flow-mediated dilation (FMD) of the brachial artery and aortic circumferential strain (ACS) for the measurement of vascular function, in addition to 3D speckle tracking echocardiography and global longitudinal strain (GLS) for left ventricular function. The degree of inflammation in JIA patients was estimated via the JADAS-10 score.</p><p><strong>Results: </strong>Both ACS and FMD were impaired in cases compared with controls (median value in cases 15 vs. 21 in controls); similarly, GLS was significantly reduced in cases (median value 17) compared with controls (22). There was a significant correlation between ACS and GLS, indicating an intimate relationship between both conditions. Impaired vascular relaxibility was associated with increased JADAS scores, suggesting a negative effect of inflammation on accelerated vascular degeneration.</p><p><strong>Conclusion: </strong>There is currently an increasing body of evidence that cardiovascular disease partly results from low-grade inflammation, and there are also speculations that subtle myocardial dysfunction results from vascular involvement with impaired coronary relaxibility. We believe that this study adds more evidence to the latter. More studies involving more patients, notably at the molecular level, are needed to validate these results and to further understand their mechanisms.</p>","PeriodicalId":54630,"journal":{"name":"Pediatric Rheumatology","volume":"23 1","pages":"88"},"PeriodicalIF":2.3,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12376456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979120","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":"Development and validation of a Pediatric Internationally agreed UltraSound Hip synovitis protocol (PIUS-hip), by the PReS imaging working party.","authors":"Daniel Windschall, Ralf Trauzeddel, Silvia Magni-Manzoni, Hatice Adiguzel-Dundar, Sven Hardt, Manuela Krumrey-Langkammerer, Lampros Fotis, Rainer Berendes, Sebastian Schua, Maria Haller, Ferhat Demir, Betul Sözeri, Faekah Gohar","doi":"10.1186/s12969-025-01134-y","DOIUrl":"10.1186/s12969-025-01134-y","url":null,"abstract":"<p><strong>Background: </strong>Whilst musculoskeletal ultrasound (MSUS) normal values for examination of the hip joint have been established for healthy children, equivalent values for patients with juvenile idiopathic arthritis (JIA), as well as internationally validated MSUS protocols for the optimal evaluation of synovitis are lacking. This study aimed to develop and validate the most sensitive MSUS protocol for the detection of hip synovitis in JIA.</p><p><strong>Methods: </strong>In consecutive JIA patients with ≥ 1 clinically affected hip joint, affected and unaffected hips underwent MSUS. Disease, demographic and clinical findings were recorded. Synovitis was graded using the pediatric OMERACT score for B-Mode (BM) and power-Doppler Mode (PD) in the longitudinal and transverse scans and the sensitivity and specificity was analyzed. Additionally anterior recess size (bone to capsula distance), capsula thickness and femoral head cartilage thickness (transverse view) were measured. Published data provided further control data for anterior recess size (children without JIA). Interobserver reliability of BM and PD was tested using Fleiss-Kappa.</p><p><strong>Results: </strong>60 patients were enrolled who had 76 hips with and 32 without clinical arthritis. BM was positive (grade ≥ 1) in 74/76 of hips with clinical arthritis (97%, sensitivity 0.97 (0.93-1.0), specificity 0.85 (0.74-0.97) versus 2/32 (6%) in hips without arthritis. PD positivity frequency was 6 (8%) in hips with arthritis versus 0 in hips without. Anterior recess size (mean ± SD) was significantly wider in patients with clinical arthritis (9.9 ± 2.5 vs 5.5 ± 1.3, p-value 0.001). Use of the cut-off of ≥ 7.2 mm resulted in an area under the curve of at least 95%, with a sensitivity of 86% and specificity of 94%. Articular capsula and femoral head cartilage thickness did not differ between patients with and without arthritis. Recess size was comparable in the internal and external control groups (n = 449). Interobserver reliability of BM and PD positivity showed excellent agreement (kappa = 0.85).</p><p><strong>Conclusions: </strong>The Pediatric internationally agreed UltraSound hip synovitis protocol (PIUS-hip) could be limited to one longitudinal scan including B-Mode scoring plus measurement of anterior recess size for maximal sensitivity and specificity for synovitis.</p>","PeriodicalId":54630,"journal":{"name":"Pediatric Rheumatology","volume":"23 1","pages":"87"},"PeriodicalIF":2.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838596","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}