Acta Anaesthesiologica Scandinavica最新文献

{"title":"Analgesia and anesthesia for closed reduction of dislocated total hip arthroplasty: Protocol for a scoping review.","authors":"Rasmus Linnebjerg Knudsen, Rikke Helene Frølund Bjulf, Aurelien-Xuan Rosendal Bahuet, Mathias Therkel Steensbæk, Anne-Sofie Linde Jellestad, Kai Henrik Wiborg Lange, Lars Hyldborg Lundstrøm, Anders Kehlet Nørskov","doi":"10.1111/aas.70006","DOIUrl":"10.1111/aas.70006","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty is a common surgical procedure, but dislocation remains a significant complication often requiring closed reduction. Current anesthetic practices for closed reduction of total hip arthroplasty vary widely, and evidence on the efficacy, safety, and cost-effectiveness of different anesthetic and analgetic regimens is limited.</p><p><strong>Methods: </strong>This scoping review follows the Joanna Briggs Institute (JBI) guidelines and PRISMA-ScR framework. A systematic search will be conducted in major databases to identify studies on anesthetic approaches for closed reduction of dislocated total hip arthroplasty. Eligible studies will include adult patients and focus on outcomes such as success rate, complications, patient satisfaction, and procedural efficiency. Data will be extracted and synthesized narratively and descriptively.</p><p><strong>Results: </strong>The review will map the existing evidence on anesthetic and analgetic regimens, including their success rates, associated complications, and cost-effectiveness. It will also highlight gaps in the literature and variations in practice across different settings.</p><p><strong>Conclusion: </strong>By summarizing current evidence and identifying research gaps, this scoping review aims to inform clinical practice and guide future studies, ultimately improving the safety, effectiveness, and efficiency of anesthetic strategies for closed reduction of dislocated total hip arthroplasties.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e70006"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466502","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":"Can intubate, cannot ventilate: A proposed algorithm to handle problems with ventilation and oxygenation after intubation.","authors":"Kjetil Fosse, Magnus Salomonsen, Sven Erik Gisvold, Bjørnar Gundersen, Trond Nordseth","doi":"10.1111/aas.70007","DOIUrl":"10.1111/aas.70007","url":null,"abstract":"<p><strong>Background and methods: </strong>Few guidelines address how to handle unanticipated ventilatory problems and hypoxemia in a successfully intubated patient. We will refer to this situation as \"can intubate-cannot ventilate.\" The situation may occur immediately after intubation or later during general anaesthesia. The aim of this paper is to describe an algorithm for handling this situation. In an intubated patient, the airway can be considered a continuum from the ventilator to the alveoli, and the problem is somewhere along this route: Ventilator → Hoses → Filter → Tracheal tube (TT) → Tracheae → Bronchi → Bronchioles → Alveoli. The proposed algorithm is based on clinical experience and has not been externally validated.</p><p><strong>Results: </strong>The first critical decision to be made is whether the TT has been placed correctly in the trachea or not. Positive wave-formed capnography is the primary marker for correct intubation. Video and/or direct laryngoscopy can be used for further verification. The patient should be disconnected from the ventilator and manually ventilated with bag-valve and 100% oxygen. An open tube should then be verified by applying a suction catheter through the tube. If these measures do not improve the situation, a fibreoptic scope should be inserted to further assess possible causes of difficult ventilation. If no obvious treatable cause is detected at this point, bronchospasm, anaphylaxis, or pneumothorax should be ruled out or treated. Further handling should focus on optimizing gas exchange in the lungs and considering more advanced treatment options to improve oxygenation and circulation.</p><p><strong>Conclusions: </strong>We have proposed an algorithm to handle unanticipated problems with ventilation and oxygenation in a patient who has been successfully intubated. Equipment failure and a blocked TT should be ruled out before diagnosing and treating medical or surgical causes of ventilatory problems.</p><p><strong>Editorial comment: </strong>This article presents a logical approach to the time-sensitive and critical situation where, for some reason, after intubation, ventilation of the lungs is not succeeding. The authors propose steps for a systematic approach, and recognition of different possible explanations for ventilation not working is informative.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e70007"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481985","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":"Comparison of all types of loop-diuretics for chronic heart failure: A protocol for a systematic review and network meta-analysis.","authors":"Sami Taleghani, Jasmin Dam Lukoschewitz, Sandra Tonning, Ida Arentz Taraldsen, Janus C Jakobsen, Johannes Grand","doi":"10.1111/aas.70005","DOIUrl":"10.1111/aas.70005","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic heart failure (CHF) experience congestion-related symptoms such as dyspnoea and oedema, both of which are associated with poor outcomes. Loop diuretics are the cornerstone to treat congestion and to maintain euvolemia. While furosemide is the most used loop diuretic, other loop diuretics may exhibit theoretical advantages. We aim to compare all types of loop diuretics for patients with CHF.</p><p><strong>Methods: </strong>This protocol for a systematic review is conducted with guidance from the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. We will include randomised clinical trials (RCTs) of loop diuretics with other loop diuretics, placebo, or standard of care in CHF patients. The search will be conducted across the major medical databases (including Medline, Embase, and Cochrane Central Register of Controlled Trials). The searches will begin in February 2025. The primary outcome will be all-cause mortality. Secondary outcomes will be all-cause hospitalization, serious adverse events (SAEs), and changes in body weight (kg). Data will be analysed by traditional meta-analyses, Trial Sequential Analyses (TSA), and network meta analysis. The risk of bias will be assessed using the Cochrane Risk of Bias tool-version 2. The certainty of the evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) and Confidence in Network Meta-Analysis (CINEMA) approach.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e70005"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439695","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":"Coagulation and platelet function in cold-stored whole blood on missions in a helicopter emergency service.","authors":"José-Gabriel Sato Folatre, Agneta Wikman, Vladimir Radulovic, Göran Sandström, Gabriel Skallsjö, Per Arnell, Sven-Erik Ricksten, Birgitta Romlin","doi":"10.1111/aas.14568","DOIUrl":"10.1111/aas.14568","url":null,"abstract":"<p><strong>Background: </strong>Haemorrhage is a leading cause of morbidity and mortality in trauma, and prehospital transfusion of blood products is often necessary. Whole blood has been proposed to be the best alternative, but it is unclear whether, and how, storage and transport of the blood in a helicopter affects the blood units. We investigated the coagulation capacity and platelet function in whole blood at different time points during helicopter missions.</p><p><strong>Methods: </strong>Twenty units of low-titre group O RhD negative whole blood were collected from healthy volunteers and analysed before, during and after transport in a helicopter. Coagulation and platelet function, as measured by thromboelastography, and blood samples for pH, electrolytes, glucose and lactate were assessed at baseline and 24, 72 and 168 h after storage in the helicopter. Plasma concentrations of coagulation factors and haemoglobin and blood counts were measured at baseline and after 168 h.</p><p><strong>Results: </strong>Plasma concentrations of coagulation factors and haemoglobin did not change during storage and transport. Platelet counts decreased from a baseline mean of 172 ± 29 × 10⁹/L to a mean of 120 ± 28 × 10⁹/L after 168 h, and platelet function worsened slightly but significantly by 8%-9% during storage and transport. pH and glucose decreased while potassium and lactate levels increased after 168 h compared with baseline.</p><p><strong>Conclusion: </strong>Storage and transport of whole-blood units in a rescue helicopter, for up to 168 h, had a slight impact on the blood quality. Storage of whole blood on board of the helicopter holds up to European standard, measured as temperature and haemolysis.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 2","pages":"e14568"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998224","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":"Accuracy of estimating equations for the assessment of glomerular filtration rate in critically ill patients versus outpatients.","authors":"Katalin Kiss, Aso Saeed, Sven-Erik Ricksten, Gudrun Bragadottir","doi":"10.1111/aas.14540","DOIUrl":"10.1111/aas.14540","url":null,"abstract":"<p><strong>Background: </strong>Estimating equations for the assessment of glomerular filtration rate (GFR) have been poorly investigated in the critical care setting. We evaluated the agreement between the GFR measured with ⁵¹CrEDTA/iohexol (mGFR) and four estimating equations based on serum concentrations of creatine and/or cystatin C (eGFR) in two cohorts: critically ill patients and outpatients with normal-to-moderately reduced GFR.</p><p><strong>Methods: </strong>Forty-three patients in the critical care group and 48 patients in the outpatient group were included. GFR was measured (mGFR) by plasma infusion clearance of ⁵¹Cr-EDTA/iohexol (critical care group) and the single injection, one-sample plasma ⁵¹Cr-EDTA clearance technique (outpatients). The following estimating equations (eGFR) were used: the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for creatinine (CKD-EPI_Cr), cystatin C (CKD-EPI_{Cys C}), creatinine+cystatin C (CKD-EPI_{Cr + Cys C}) and the Lund-Malmö creatinine+cystatin C equation (LM_{Cr + Cys C}). Agreement between mGFR and eGFR was assessed by the Bland-Altman method and accuracy by calculating P30 and P10.</p><p><strong>Results: </strong>In the critically ill group, the bias between the estimating equations and mGFR was -3.6 to 2.8 mL/min/1.73 m², while the error was 121%-127% and the accuracy (P30) 33%-40%. In the outpatients, the bias between the estimating equations and mGFR was -13.0 to 7.6 mL/min/1.73 m², while the error was 31%-41% and the accuracy (P30), 67%-96%.</p><p><strong>Conclusions: </strong>All four equations performed poorly in assessing GFR in the critically ill cohort with an unacceptably high error and low accuracy in contrast to the outpatient group. To accurately assess GFR in critically ill patients, GFR must be measured not estimated.</p><p><strong>Editorial comment: </strong>For the assessment of glomerular filtration rate (GFR), it can be measured directly, but is frequently estimated using a point measure of serum creatinine concentration. In this study, ICU case GFR estimations, by different adjusted equations, done also for a cohort of outpatients, showed that these serum creatinine-based estimations for ICU cases are not highly precise or reliable.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"e14540"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492653","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":"Efficacy and safety of a 72-h infusion of prostacyclin (1 ng/kg/min) in mechanically ventilated patients with pulmonary infection and endotheliopathy-protocol for the multicenter randomized, placebo-controlled, blinded, investigator-initiated COMBAT-ARF trial.","authors":"Peter Søe-Jensen, Niels E Clausen, Morten H Bestle, Lars P K Andersen, Theis Lange, Pär I Johansson, Jakob Stensballe","doi":"10.1111/aas.14565","DOIUrl":"10.1111/aas.14565","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory failure (ARF) is common in critically ill patients, and 50% of patients in intensive care units require mechanical ventilation [3, 4]. The COVID-19 pandemic revealed that COVID-19 infection induced ARF caused by damage to the microvascular pulmonary endothelium. In a randomized clinical trial, mechanically ventilated COVID-19 patients with severe endotheliopathy, as defined by soluble thrombomodulin (sTM) ≥ 4 ng/mL, were randomized to evaluate the effect of a 72-h infusion of low-dose prostacyclin 1 ng/kg/min or placebo. Twenty-eight-day mortality was 21.9% versus 43.6% in the prostacyclin and the placebo groups, respectively (RR 0.50; CI 0.24 to 0.96 p = .06). The aim of the current trial is to investigate if this beneficial effect and safety of prostacyclin also are present in any patient with suspected pulmonary infection requiring mechanical ventilation and concomitant severe endotheliopathy.</p><p><strong>Materials and methods: </strong>This is a multi-center, randomized, blinded, clinical investigator-initiated phase 3 trial in mechanically ventilated patients with suspected pulmonary infection and severe endotheliopathy, as defined by sTM ≥4 ng/mL. Patients are randomized 1:1 to a 72-h infusion of low-dose prostacyclin (iloprost) 1 ng/kg/min or placebo (an equal volume of saline). Four-hundred fifty patients will be included. The primary endpoint is 28-day all-cause mortality. Secondary endpoints include 90-day mortality, days alive without vasopressor, mechanical ventilation, and renal replacement therapy in the ICU within 28 and 90 days, and the number of serious adverse reactions or serious adverse events within the first 7 days.</p><p><strong>Discussion: </strong>This trial will investigate the efficacy and safety of prostacyclin vs. placebo for 72-hours in mechanically ventilated patients with any suspected pulmonary infection and severe endotheliopathy, as defined by sTM ≥4 ng/mL. Trial endpoints focus on the potential effect of prostacyclin to reduce 28-day all-cause mortality.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 1","pages":"e14565"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862513","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":"Postoperative pain management in patients with preexisting opioid dependence-A scoping review protocol.","authors":"Nikoline Svensson, Magnus Grønbæk Henriksen, Ann Merete Møller","doi":"10.1111/aas.14556","DOIUrl":"10.1111/aas.14556","url":null,"abstract":"<p><strong>Background: </strong>Opioid-dependent patients with chronic pain conditions present a significant challenge for anesthesiologists when managing acute postsurgical pain. Opioid-dependent patients can experience tolerance, physical dependence, and hyperalgesia. These patients have an increased risk of poorly managed acute postoperative pain, which can ultimately lead to suffering and potentially an overall increase in length of hospitalization and healthcare cost. However, this is an under-researched field. This scoping review aims to investigate effective strategies in managing postoperative pain in patients with preexisting opioid dependence.</p><p><strong>Methods: </strong>A scoping review will be conducted on postoperative pain management in patients with preexisting opioid dependence. This review will be prepared according to the JBI methodology for scoping reviews and to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). We will conduct a comprehensive search across multiple databases. Backward citation searching of the final included articles will also be conducted. Data extraction will include trial and participant characteristics, intervention details, and reported outcomes.</p><p><strong>Results: </strong>In the final review the results will be presented as a descriptive summary with supplementary tables, figures, and graphs where applicable.</p><p><strong>Conclusion: </strong>The planned scoping review will map out the current evidence about effective strategies to manage postoperative pain in patients with preexisting opioid dependence. We will aim to identify research gaps that can be used as support in the development of further research.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 1","pages":"e14556"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765308","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":"Thromboelastography or rotational thromboelastometry guided algorithms in bleeding patients: An updated systematic review with meta-analysis and trial sequential analysis.","authors":"A D Kvisselgaard, S A Wolthers, A Wikkelsø, L B Holst, B Drivenes, A Afshari","doi":"10.1111/aas.14558","DOIUrl":"10.1111/aas.14558","url":null,"abstract":"<p><strong>Background: </strong>Bleeding patients face significant morbidity and mortality due to impaired haemostasis. Haemostatic resuscitation has evolved, yet the optimal approach remains unclear. The primary objective was to assess the benefits and risks of transfusion guided by TEG/ROTEM versus standard of care in bleeding patients in an updated review.</p><p><strong>Methods: </strong>This systematic review of randomised controlled trials with meta-analyses and trial sequential analysis was conducted according to Cochrane Collaboration methodology, PRISMA and GRADE guidelines. A literature search was conducted in five major databases. Both paediatric and adult patients were included. The primary outcome was mortality, and secondary outcomes were the administration of blood products, blood loss, surgical reintervention, and dialysis-dependent renal injury.</p><p><strong>Results: </strong>This systematic review included 31 randomised trials (n = 2756), with most patients undergoing elective cardiac surgery. TEG-/ROTEM-guided algorithms reduced the amount of transfused fresh frozen plasma (RR 0.5, 95% CI 0.32-0.72, I²: 94%), platelets (RR 0.7, 95% CI 0.55-0.91, I²: 57%), the risk for surgical reintervention (RR 0.65, 95% CI 0.47-0.94, I²: 0%), and bleeding with a standard mean difference of -0.31 (95% CI -0.55 to -0.08, I²: 75%). No statistically significant difference was demonstrated for mortality (RR 0.76, 95% CI 0.57-1.00, I²: 5%). According to GRADE methodology, the certainty of the evidence was very low for all outcomes. Trial sequential analysis of mortality analysis indicated that 54% of the optimal information size was reached with an alpha-boundary RR of 0.81 (95% CI 0.63-1.03).</p><p><strong>Conclusions: </strong>TEG-/ROTEM-guided transfusion algorithms may reduce the risk of mortality, bleeding volume, and the need for fresh frozen plasma and platelets, but the evidence is very uncertain. Further, the results were primarily based on the adult population undergoing elective cardiac surgery.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 1","pages":"e14558"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765325","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":"Correction to 'Restrictive versus standard IV fluid therapy in adult ICU patients with septic shock-Bayesian analyses of the CLASSIC trial'.","authors":"","doi":"10.1111/aas.14530","DOIUrl":"10.1111/aas.14530","url":null,"abstract":"","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"e14530"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455397","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":"Correction to Patients with aneurysmal subarachnoid haemorrhage treated in Swedish intensive care: A registry study.","authors":"","doi":"10.1111/aas.14538","DOIUrl":"10.1111/aas.14538","url":null,"abstract":"","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"e14538"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492654","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}