Archives De Pediatrie最新文献

{"title":"Uncorrected ametropia in children with limited access to ocular health care.","authors":"Omri Clair, Christine Morisset, Rayan Mekoui, Solène De Hedouville, Flavien Lefebvre, Emmanuel Marciano, Emmanuel Bui Quoc","doi":"10.1016/j.arcped.2024.10.008","DOIUrl":"https://doi.org/10.1016/j.arcped.2024.10.008","url":null,"abstract":"<p><strong>Introduction: </strong>The primary objective of this study is to describe the refractive needs of vulnerable children according to their social security status. The secondary objective of this study is to describe the types of ametropia in this population of children with limited access to ocular health care.</p><p><strong>Methods: </strong>Children with limited access to ocular health care were recruited. Their social security status was assessed as well as their need for optical correction. Children received an orthoptic and ophthalmological examination. The ametropia thresholds requiring optical correction were defined as follows: hyperopia if spherical equivalent (SE) ≥ 3D before 6 years, ≥ 2.25 D between 6 and 12 years, ≥ 1.5 D from 12 years onwards; myopia if SE ≤ 0.5 D; astigmatism if cylinder C ≥ 1D; anisometropia if sphere difference between both eyes ≥ 1D.</p><p><strong>Results: </strong>Out of 83 planned patients, 60 children turned up. 51 files for children aged 1 to 14 years old were analysed. 63.2 % of children without social security required an optical correction, compared with 65.6 % of children receiving State Medical Aid (SMA) and 66.7 % of children receiving Universal Health Protection (UHP). Out of 102 eyes, SE was hypermetropic in 56.9 % of cases, myopic in 21.6 % of cases; astigmatism was present in 60.8 % of cases. Anisometropia was assessed in 27.5 % of cases. 33 children out of 51 (64.7 %) required correction with glasses.</p><p><strong>Discussion and conclusion: </strong>Children benefiting from SMA or UHP have similar refractive needs than children without social security, and probably greater than those of the general population. In our population there is two-thirds of patients with ametropia requiring optical correction; most of these children did not initially wear glasses, which suggests that access to ophthalmic and optical care is more difficult for vulnerable children.</p>","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of physical activity in obese adolescents in Algeria.","authors":"Fouzia Yous, Salim Zaabar, Omar Aoun, Nawel Adjeroud-Abdellatif, Radia Arab, Khodir Madani","doi":"10.1016/j.arcped.2024.09.009","DOIUrl":"https://doi.org/10.1016/j.arcped.2024.09.009","url":null,"abstract":"<p><strong>Objective: </strong>Adolescents are meant to spend a large part of their time practicing a hobby or sport, but currently there is a decline in their level of physical activity and sport both inside and outside schools, which can lead to a risk of obesity. The objective of the present study was to examine physical activity in obese adolescents within the school establishments of the province of Bejaia (northeastern Algeria).</p><p><strong>Method: </strong>To determine the physical activity level (PAL) in the school population, a sample of 3,038 students with obesity comprising 1,635 girls and 1,403 boys was selected. The study focused on (a) the comparison of the intensity of physical activities practiced by girls and boys, (ii) the determination of the duration, intensity, and level of physical activity.</p><p><strong>Results: </strong>The results show that obese girls are less active than obese boys at all ages (from 11 to 23 years) and in all locations; PALs was steady with increasing age for girls, while PALs increase with age in boys from 17 to 21. We found that some factors are associated with a decrease in PAL, such as the time spent watching television. Doing only 30 min of physical activity once a week is associated with an increase in sedentary behavior. The mean PALs of middle school (1.54) and high school (1.50) girls were lower than those observed for middle school (1.75) and high school (1.65) boys.</p><p><strong>Conclusions: </strong>Our results show that obese girls are less active than obese boys and spend time watching television and practicing sports only at school.</p>","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thigh and paraspinal muscles change after fusionless bipolar fixation for early onset scoliosis in type 2 spinal muscular atrophy","authors":"Mathilde Gaume ,&nbsp;Claudio Vergari ,&nbsp;Maud Creze ,&nbsp;Aurore Bonnet-Lebrun ,&nbsp;Christophe Muth-Seng ,&nbsp;Susana Quijano-Roy ,&nbsp;Lotfi Miladi ,&nbsp;Wafa Skalli ,&nbsp;Robert-Yves Carlier","doi":"10.1016/j.arcped.2024.08.005","DOIUrl":"10.1016/j.arcped.2024.08.005","url":null,"abstract":"<div><h3>Background</h3><div>Spinal muscular atrophy is a severe, progressive autosomal recessive neuromuscular disorder associated with neuromuscular scoliosis. When bracing is not sufficient to control the deformity, early spinal surgery is required. To the best of our knowledge, no work in the literature have assessed modifications in spinal and thigh muscles of subjects with type 2 spinal muscular atrophy (SMA2) following spinal surgery.</div></div><div><h3>Objective</h3><div>This study aimed to better understand modifications in the spinal and thigh muscles of subjects with SMA2 and early onset scoliosis, before and after minimally invasive fusionless surgery.</div></div><div><h3>Methods and settings</h3><div>20 SMA2 patients with confirmed scoliosis on bi-planar low-dose X-ray were included: 10 preoperative and 10 postoperative patients with a minimal follow-up of 5 years after surgery. The surgery consisted of a bilateral sliding rod construct extended from T1 to the sacrum, through a minimally invasive approach. All subjects had fat/water separation muscle magnetic resonance imaging from the spine to the thigh. The percentage of fat degeneration was compared before and after surgery. A quality-of-life survey was performed.</div></div><div><h3>Results</h3><div>Fat infiltration was diffuse and symmetric in both groups of patients, and on average six times more compared to control subjects previously published at thigh level. Adductors, sartorius, and gracilis were less affected with respectively, 51%, 56%, and 57% of fat fraction before surgery. Comparing the preoperative and postoperative groups, fat infiltration was higher in sartorius and multifidus after surgery (<em>p</em> &lt; 0.05). No significant difference was found for the other muscles studied. These results did not affect quality of life.</div></div><div><h3>Conclusion</h3><div>This is the first study to compare fat infiltration of spinal and thigh muscles of SMA2 patients before and after minimally invasive surgery. Our results demonstrate that muscles were globally preserved apart from multifidus and sartorius which were more affected.</div></div>","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":"32 1","pages":"Pages 12-17"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of early discharge from the maternity ward on the risk of neonatal rehospitalization: A case-control study","authors":"Cassandra VAROQUI ,&nbsp;Abdou Yacoubou OMOROU ,&nbsp;Laurélia JOURDAN ,&nbsp;Jean-Michel HASCOET","doi":"10.1016/j.arcped.2024.09.003","DOIUrl":"10.1016/j.arcped.2024.09.003","url":null,"abstract":"<div><h3>Background</h3><div>The time for newborn discharge from the maternity ward has been shortened in recent decades with consequences that are still debated.</div></div><div><h3>Objectives</h3><div>The primary objective of this study was to establish whether early discharge could be a risk factor for rehospitalization in the neonatal period. Second, we aimed to study the incidence of neonatal hospitalizations and their causes. Next, we tried to determine other possible risk factors for rehospitalization after discharge.</div></div><div><h3>Methods and Setting</h3><div>This is a retrospective, single-center, case-control study collecting data on newborns rehospitalized in the first 28 days of life at Nancy University Hospital, after their discharge from the maternity ward. These newborns were born between 01/06/2021 and 31/05/2022 and were matched with two healthy infants who did not require rehospitalization according to term and month of birth. A logistic regression model was used to evaluate the association between early discharge and risk of hospitalization.</div></div><div><h3>Results</h3><div>2,054 healthy full-term babies were born during the study period; 108 (5%) were rehospitalized and compared to 219 randomly selected newborns who did not required hospitalization. Among the 108 cases included, 42 (38.9%) obtained early discharge versus 91 out of 219 (41.6%) controls. Multivariate logistic regression showed no significant association between early discharge and risk of hospitalization (ORa=1.1 [95%CI: 0.7 to 1.8], <em>p</em> = 0.69). However, phototherapy treatment during the maternity ward stay was a significant risk factor for rehospitalization (ORa=5.O [2.5 to 9.9], <em>p</em> &lt; 0.0001). The main causes of hospitalization were jaundice and respiratory infections.</div></div><div><h3>Conclusion</h3><div>Early discharge from the maternity ward does not constitute a risk factor for readmission in the neonatal period in this study. Changes in perinatal practices, such as ambulatory delivery and very early discharge, should be included in revised recommendations.</div></div>","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":"32 1","pages":"Pages 58-65"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Cow's milk-based infant formula supplements in breastfed infants and primary prevention of cow's milk allergy: A commentary of the Committee on Nutrition of the French Society of Pediatrics","authors":"Dominique Sabouraud-Leclerc ,&nbsp;Elena Bradatan ,&nbsp;Tomas Moraly ,&nbsp;François Payot ,&nbsp;Anne Broué-Chabbert ,&nbsp;Rachel Pontcharraud ,&nbsp;Carine Larue ,&nbsp;Ariane Nemni ,&nbsp;Agnès Juchet ,&nbsp;Patrick Tounian","doi":"10.1016/j.arcped.2024.10.004","DOIUrl":"10.1016/j.arcped.2024.10.004","url":null,"abstract":"","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":"32 1","pages":"Pages 77-78"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caregiver satisfaction with the use of continuous glucose monitoring and flash glucose monitoring in very young children with type 1 diabetes","authors":"Karine Aouchiche ,&nbsp;Delphine Bernoux ,&nbsp;Elisabeth Baechler Sadoul ,&nbsp;Elsa Haine ,&nbsp;Florence Joubert ,&nbsp;Sophie Epstein ,&nbsp;Noémie Faure Galon ,&nbsp;Fabienne Dalla-Vale ,&nbsp;Jean․-Charles Combe ,&nbsp;Martine Samper ,&nbsp;Gilbert Simonin ,&nbsp;Sarah Castets ,&nbsp;Emeline Marquant ,&nbsp;Julia Vergier ,&nbsp;Rachel Reynaud","doi":"10.1016/j.arcped.2024.09.005","DOIUrl":"10.1016/j.arcped.2024.09.005","url":null,"abstract":"<div><h3>Background</h3><div>New technologies for the management of children with type 1 diabete (T1D) are constantly and rapidly evolving. However, few real-life studies have been conducted, and rarely in the youngest patients (&lt;6 years).</div></div><div><h3>Aim</h3><div>To study parental satisfaction with continuous and flash glucose monitoring devices in young children with T1D.</div></div><div><h3>Methods</h3><div>A questionnaire was completed by the parents of 114 children under the age of 6 years with T1D treated with an insulin pump followed-up in one of the hospitals of the French ADIM network between January and July 2020.</div></div><div><h3>Results</h3><div>One hundred and nine patients (96 %) were equipped with a glucose monitor and 95 % (104/109) of parents stated that they were satisfied or very satisfied with their child's monitoring device, with no significant difference in satisfaction rates between flash and continuous glucose monitoring. The parameter most strongly associated with satisfaction was confidence in the reliability of the device (<em>p</em> = 0.008). Parents who struggled to apply the device were significantly less satisfied (<em>p</em> = 0.024). In real-life use, 83 % of parents (90/109) used additional adhesives, 28 % reported mild skin reactions (30/108) and 39 % severe skin reactions (42/108), 50 % stated that applying the device was not painful, and 95 % found the device easy to apply. The most commonly reported unexpected difficulties were device malfunction (by 16 respondents), the device being too large and causing scarring (6 respondents), and lengthy calibration (6 respondents).</div></div><div><h3>Conclusion</h3><div>The vast majority of parents in this group of young children with T1D were satisfied with continuous or flash glucose monitoring. Satisfaction was strongly associated with confidence in the reliability of the device. Reported adverse effects such as skin reaction and difficulties attaching the device highlight the importance of data on real-life use.</div></div>","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":"32 1","pages":"Pages 36-40"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Medical management of vegetarian and vegan children in France: Medical practices and parents’ perceptions","authors":"Damien Denimal","doi":"10.1016/j.arcped.2024.10.005","DOIUrl":"10.1016/j.arcped.2024.10.005","url":null,"abstract":"","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":"32 1","pages":"Pages 79-80"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Actual food consumption after a negative oral food challenge in children: A challenge after the challenge?","authors":"Inès Himeur ,&nbsp;Delphine Pouradier ,&nbsp;Hélène Lengliné ,&nbsp;Flore Amat","doi":"10.1016/j.arcped.2024.09.004","DOIUrl":"10.1016/j.arcped.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Unnecessary dietary eliminations may impair quality of life, affect children's growth, and negatively impact healthcare costs. Previous studies reported that around 11 % to 28 % of children continue a food-avoidance diet despite a negative oral food challenge (OFC).</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate the actual consumption at home of the tested food after a negative OFC and the reasons reported by families in the case of persistent avoidance.</div></div><div><h3>Methods and settings</h3><div>A retrospective study was conducted in the Pediatric Gastro-Enterology and Pneumo-Allergology Departments of Robert Debré Hospital (Paris), involving patients who had a negative OFC. Data were collected from the patients’ medical files and supplemented by a telephone survey.</div></div><div><h3>Results</h3><div>101 families completed the telephone survey, corresponding to 129 OFCs with full data available. The tested foods were tree nuts for 29.5 % (38/129), milk for 28.7 % (37/129), and egg for 21 % (27/129). Persistent avoidance represented 17.1 % of the OFCs (22/129), and partial consumption 4.6 % (6/129). Consumption of the tested food was inversely correlated with child's age and length of avoidance period. Consumption was more frequent in the case of ubiquitous allergens (milk, egg). The main causes mentioned for non-consumption were family habits (72.7 %, 16/22) or the child's disgust for the tested food (54.5 %, 12/22).</div></div><div><h3>Conclusion</h3><div>A negative OFC does not always result in actual consumption of the tested food at home. These results underline the importance of performing an OFC as early as possible in the patient's life. Monitoring and supporting patients who have a negative OFC is key for successful consumption at home.</div></div>","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":"32 1","pages":"Pages 48-51"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between visceral adipose tissue and glomerular hyperfiltration in adolescents: A cross-sectional study","authors":"Yong-Chang Yang,&nbsp;Jing-Ying Zhao,&nbsp;Cheng-Guang Zhao","doi":"10.1016/j.arcped.2024.08.007","DOIUrl":"10.1016/j.arcped.2024.08.007","url":null,"abstract":"<div><h3>Objective</h3><div>Glomerular hyperfiltration is an early indicator of obesity-related glomerular disease. However, in adolescents, there are no quantifiable indicators of obesity and glomerular hyperfiltration. This study investigates the association between visceral adipose tissue and glomerular hyperfiltration in adolescents.</div></div><div><h3>Methods</h3><div>This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES; 2011–2018), and adolescents aged 12–17 years were included. Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) formed the independent variables while estimated glomerular filtration rate (eGFR) acted as the dependent variable. Their association was assessed using unadjusted and multivariate regression analyses, as well as subgroup and interaction analyses.</div></div><div><h3>Results</h3><div>Multivariate regression analysis revealed that VAT was positively associated with eGFR and glomerular hyperfiltration among adolescents. The incidence of glomerular hyperfiltration increased by 99 % in boys and 56 % in girls per 100 g of VAT increase. Additionally, VAT and eGFR exhibited a linear relationship in both boys (<em>β</em> = 5.63, <em>p</em> &lt; 0.001) and girls (<em>β</em> = 2.72, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>In US adolescents aged 12–17 years, VAT was positively correlated with eGFR and glomerular hyperfiltration.</div></div>","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":"32 1","pages":"Pages 24-29"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a nurse-driven noninvasive respiratory support discontinuation protocol in infants with severe bronchiolitis","authors":"Julie Cassibba ,&nbsp;Marie Chevallier ,&nbsp;Aurélie Alexandre ,&nbsp;Alice Fumagalli ,&nbsp;Brigitte Fauroux ,&nbsp;Guillaume Mortamet","doi":"10.1016/j.arcped.2024.08.006","DOIUrl":"10.1016/j.arcped.2024.08.006","url":null,"abstract":"<div><h3>Background</h3><div>To evaluate a nurse-driven respiratory support discontinuation protocol in infants with bronchiolitis admitted in paediatric intensive care units.</div></div><div><h3>Methods</h3><div>A retrospective single-center study with pre-versus-post comparative design in a tertiary center<em>.</em></div></div><div><h3>Results</h3><div>In total, 187 infants (95 with standard and 92 with nurse-driven protocols) were included. There was no difference in terms of weaning failure between the two periods (11 (12 %) <em>versus</em> 14 (15 %), <em>p</em> = 0.46). During the nurse-driven protocol period, discontinuation of the ventilatory support was performed later (at 44 hrs (IQR 29–67) <em>versus</em> 33 hrs (IQR 19–46), <em>p</em> = 0.001), but the weaning process duration was shorter than before protocol implementation (24 h (IQR 0–60) <em>versus</em> 39 (IQR 18–64), <em>p</em> = 0.01). The total duration of ventilation (excluding time on BiPAP) was similar before and after protocol (53 (IQR 37–81) <em>versus</em> 55 h (IQR 28–81), <em>p</em> = 0.46). The PICU and hospital lengths of stay did not differ between the two periods.</div></div><div><h3>Conclusions</h3><div>In patients with bronchiolitis supported by noninvasive respiratory support, the nurse-driven discontinuation management - as opposed to physician-driven – was associated with a later discontinuation of the ventilatory support, while the weaning process duration was shorter than before protocol implementation.</div></div>","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":"32 1","pages":"Pages 18-23"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}