JACC advances最新文献

{"title":"Adults With Congenital Heart Disease Have an Increased Prevalence of Autoimmunity","authors":"William Liu ,&nbsp;Insoo Kang MD ,&nbsp;Keith A. Choate MD, PhD ,&nbsp;Robert W. Elder MD","doi":"10.1016/j.jacadv.2025.102116","DOIUrl":"10.1016/j.jacadv.2025.102116","url":null,"abstract":"<div><h3>Background</h3><div>Adult congenital heart disease (ACHD) individuals have increased risk of noncardiac comorbidities including cancer and infections. Whether they are at increased risk of autoimmunity is unknown.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to understand the association of ACHD and risk for autoimmunity.</div></div><div><h3>Methods</h3><div>A case-control study was performed using All of Us, a nationwide biomedical database. In 2024, we queried autoimmune conditions and ACHD individuals ≥18 year of age with congenital heart disease (CHD) diagnoses determined using SNOMED, International Classification of Diseases (ICD)-9-CM, and ICD-100-CM classifications. ACHD individuals were matched 1:20 to controls for age, race, sex, smoking, and obesity. We examined subcategories of mild/moderate/severe CHD.</div></div><div><h3>Results</h3><div>Among 287,012 participants, 2941 ACHD (1.02%) individuals (mean age 62 years, 55.3% female) were identified. ACHD individuals had increased odds of autoimmunity (OR: 1.95; <em>P</em> &lt; 0.05), both systemic (OR: 1.94; <em>P</em> &lt; 0.05) and organ specific (OR: 1.54; <em>P</em> &lt; 0.05) conditions. Sixty-nine percent had sufficient detail to be classified into mild/moderate/severe CHD; severe group was smaller and younger (n = 162, mean age = 47.6 years) compared to mild (n = 1169, mean age = 63.8) and moderate (n = 703, mean age = 61.8 years) groups. Mild and moderate CHD were associated with autoimmunity (OR: 1.93; <em>P</em> &lt; 0.05 and OR: 1.56; <em>P</em> &lt; 0.05, respectively). The entire severe CHD group did not show an increase in odds of autoimmunity (OR: 1.45; <em>P</em> = 0.168). When the groups were subdivided by age, severe ACHD individuals ≥60 years did show increased odds of autoimmunity (OR: 2.71; <em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>ACHD individuals showed a nearly 2-fold increased odds of developing autoimmune conditions, both for systemic and organ-specific autoimmunity, which persisted among those with simple/moderate CHD. In an age-related analysis, the severe CHD group ≥60 years has a similar risk.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102116"},"PeriodicalIF":0.0,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconsidering Routine DNR Reversal for Interventional Cardiac Procedures.","authors":"Kaitlyn A Stoehr, Jay R Malone","doi":"10.1016/j.jacadv.2025.102115","DOIUrl":"https://doi.org/10.1016/j.jacadv.2025.102115","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":" ","pages":"102115"},"PeriodicalIF":0.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immature Surfactant Protein Type-B Associates With Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting","authors":"Sonia Eligini PhD ,&nbsp;Erica Gianazza PhD ,&nbsp;Fabrizio Veglia PhD ,&nbsp;Lisa Brocca BSc ,&nbsp;Laura Cavallotti MD ,&nbsp;Giulia Giusy Papaianni BSc ,&nbsp;Daniele Andreini MD, PhD ,&nbsp;Mauro Pepi MD ,&nbsp;Gianluca Polvani MD ,&nbsp;Elena Tremoli PhD ,&nbsp;Alessandro Parolari MD ,&nbsp;Piergiuseppe Agostoni MD ,&nbsp;Cristina Banfi PhD","doi":"10.1016/j.jacadv.2025.102119","DOIUrl":"10.1016/j.jacadv.2025.102119","url":null,"abstract":"<div><h3>Background</h3><div>Coronary artery bypass graft (CABG) surgery is performed in patients with complex multivessel coronary artery disease, but long-term graft occlusion remains a major limitation. The immature surfactant protein type-B (proSP-B) has emerged as a predictor of adverse cardiovascular outcomes.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to examine the relationship between preoperative plasma proSP-B and graft occlusion 18 months post-CABG. The aims were to evaluate whether elevated proSP-B could predict graft occlusion and to assess its predictive value within a multivariable model for long-term graft patency.</div></div><div><h3>Methods</h3><div>We evaluated proSP-B in relation to graft occlusion in 40 patients with occluded grafts (cases) and 130 patients without occlusions (noncases), with 18-month graft patency assessed by coronary computed tomography angiography and/or invasive angiography. Logistic regression assessed the association between proSP-B and graft occlusion. Predictive performance was evaluated using receiver-operating characteristic curves and category-free net reclassification improvement.</div></div><div><h3>Results</h3><div>Preoperative proSP-B was significantly elevated in cases compared to noncases (24.0 [IQR: 19.8-31.0] AU vs 19.4 [IQR: 14.0-25.0] AU; <em>P</em> = 0.002). In a multivariable analysis, proSP-B associated with increased risk of graft occlusion, even after adjusting for factors like D-dimer, left ventricular ejection fraction, and extracorporeal circulation time. Including proSP-B in a reference model improved the area under the curve from 0.7204 to 0.7733, significantly enhancing patient classification (net reclassification improvement = 0.43; SE = 0.18; <em>P</em> = 0.02).</div></div><div><h3>Conclusions</h3><div>Elevated preoperative proSP-B is independently associated with 18-month graft occlusion following CABG. Including proSP-B improves existing predictive models, supporting its role as a novel biomarker for risk stratification in surgical revascularization.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102119"},"PeriodicalIF":0.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of Intravascular Coronary Lithotripsy in the United States","authors":"Abdul Rasheed Bahar MD ,&nbsp;Yasemin Bahar MD ,&nbsp;Ali Rabib MD ,&nbsp;Nouraldeen Manasrah MD ,&nbsp;Fethi Onal MD ,&nbsp;Olayiwola Bolaji MD ,&nbsp;Aiden Abidov MD, PhD ,&nbsp;M. Chadi Alraies MD, MPH","doi":"10.1016/j.jacadv.2025.102099","DOIUrl":"10.1016/j.jacadv.2025.102099","url":null,"abstract":"<div><h3>Background</h3><div>Disparities in health care access persist in cardiovascular interventions. Coronary lithotripsy, a novel treatment for calcified coronary lesions, shows variability in utilization by sociodemographic factors.</div></div><div><h3>Objectives</h3><div>This study examines the impact of sex, race, income, and hospital characteristics on lithotripsy use in the United States.</div></div><div><h3>Methods</h3><div>Using the 2021 Nationwide Inpatient Sample, patients undergoing percutaneous coronary intervention were identified. Lithotripsy was defined by the International Classification of Diseases-10th Revision codes. Multivariable logistic regression assessed the impact of sociodemographic factors, adjusting for comorbidities and hospital characteristics. Outcomes were compared using propensity score matching, with <em>P</em> &lt; 0.05 considered significant.</div></div><div><h3>Results</h3><div>Of 261,260 percutaneous coronary intervention patients, 1,000 (0.38%) underwent lithotripsy. Adjusted analyses revealed that women were less likely to receive lithotripsy than men (adjusted OR [aOR]: 0.65; 95% CI: 0.53-0.79; <em>P</em> &lt; 0.001). African American patients had lower odds of receiving lithotripsy than Whites (aOR: 0.66; 95% CI: 0.48-0.93; <em>P</em> = 0.016). Medicaid patients were less likely to receive lithotripsy (aOR: 0.20; 95% CI: 0.11-0.36; <em>P</em> &lt; 0.001) compared to Medicare beneficiaries. Higher-income quartiles increased odds of receiving lithotripsy compared to lower quartiles (aOR: 1.38-1.6; <em>P</em> &lt; 0.05). Regional disparities were noted, with lower use in the South (aOR: 0.66; 95% CI: 0.47-0.94; <em>P</em> = 0.022).</div></div><div><h3>Conclusions</h3><div>Disparities in lithotripsy utilization persist, driven by sex, race, insurance status, income, and geographic region. These findings emphasize the need for targeted interventions to promote equitable access to advanced cardiovascular therapies. While some disparities may reflect differences in disease prevalence, persistent inequities in treatment allocation warrant further investigation.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102099"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144922888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Genetic Background Affect Susceptibility to Alcohol-Induced Heart Disease?","authors":"Samuel J Tu, Emma M Rath, Eleni Giannoulatou, Diane Fatkin, Christopher X Wong","doi":"10.1016/j.jacadv.2025.102049","DOIUrl":"10.1016/j.jacadv.2025.102049","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 9","pages":"102049"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptom Preoccupation in Atrial Fibrillation and its Association With Quality of Life: A Cross-Sectional Study.","authors":"Björn Erik Liliequist, Brjánn Ljótsson, Eva Ólafsdóttir, Frieder Braunschweig, Josefin Särnholm","doi":"10.1016/j.jacadv.2025.102058","DOIUrl":"10.1016/j.jacadv.2025.102058","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) often manifests with distressing symptoms, impaired quality of life (QoL), and increased health care consumption. Rhythm and rate control treatments may have limited impact on QoL. Symptom preoccupation, that is, fear of cardiac-related symptoms and avoidance behavior, may contribute to disability in AF but remains understudied.</p><p><strong>Objectives: </strong>The objective of the study was to investigate the prevalence of symptom preoccupation in AF and its association with impaired QoL, general disability, symptom severity, and health care visits, in a general AF sample.</p><p><strong>Methods: </strong>This cross-sectional study recruited 409 Swedish AF patients who completed an online survey on demographics, medical history, and measures of AF-specific QoL (AF effects on QoL; AFEQT), general disability, AF health care use, and symptom preoccupation (Cardiac Anxiety Questionnaire) and other psychological variables, including depression and general anxiety.</p><p><strong>Results: </strong>Symptom preoccupation was present in 37% of respondents (59% females and 23% males) and showed the strongest association with impaired QoL (regression coefficient [β]: -0.51; 95% CI: -0.61 to -0.41; P < 0.001), health care use (incidence rate ratio: 1.67; 95% CI: 1.28-2.19; P < 0.001), and symptom severity (β: 0.39; 95% CI: 0.27-0.50; P < 0.001). Depression was most strongly associated with general disability (β: 0.45; 95% CI: 0.32-0.58; P < 0.001), whereas symptom preoccupation also showed a significant but weaker association (β: 0.31; 95% CI: 0.19-0.43; P < 0.001) with general disability.</p><p><strong>Conclusions: </strong>Symptom preoccupation is common in AF patients. Behavioral interventions that specifically target symptom preoccupation could potentially increase QoL, reduce health care use, and improve symptom experience in AF.</p>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 9","pages":"102058"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation and Impact of Postdischarge Support of Cardiovascular Patients Using Text Messages The HeartHealth Program.","authors":"Brodie Sheahen, Simone Marschner, Haeri Min, Aravinda Thiagalingam, David Pryce, Robert Denniss, Pramesh Kovoor, Dylan Wynne, Anupama Balasuriya Indrawansa, Clara K Chow","doi":"10.1016/j.jacadv.2025.102017","DOIUrl":"10.1016/j.jacadv.2025.102017","url":null,"abstract":"<p><strong>Background: </strong>The HeartHealth program is a text message support program for cardiovascular patients in Western Sydney, Australia. It comprised regular semipersonalized text messages providing cardiovascular disease information, advice, and support over a 6-month period.</p><p><strong>Objectives: </strong>This study aimed to examine the impact of the HeartHealth program on health care service utilization.</p><p><strong>Methods: </strong>This is an observational study that compared hospitalization rates in patients who enrolled in the HeartHealth program to patients who did not. Patients ≥18 years old who attended cardiology clinics or were discharged from the cardiology unit at Westmead Hospital between April 2020 and April 2022 were invited to participate in HeartHealth. The primary outcome was the incidence rate of all-cause health care utilization events in the 6 months postdischarge. All analyses were adjusted for demographic and comorbidity variables.</p><p><strong>Results: </strong>11,542 patients were included in the analysis (intervention: 4,324, control: 7,218), with a mean age of 58.8 ± 17.0 years, and 60.7% (7,003/11,535) were male. HeartHealth participants had lower rates of health care service events compared to control participants (number of events per patient: 0.43 intervention vs 0.52 control; adjusted rate ratio [RR]: 0.91 [95% CI: 0.83-0.99]; P = 0.033). There was a greater reduction in health care utilization events in older (>65 years old) compared to younger patients (RR: 0.82; 95% CI: 0.72-0.93 vs RR: 0.98; 95% CI: 0.87-1.10, respectively; interaction P = 0.043). HeartHealth participants reported that the program improved diet, physical activity levels, and medication compliance.</p><p><strong>Conclusions: </strong>This analysis demonstrates the potential of text message-based postdischarge support for cardiovascular disease patients to decrease their need for health care service utilization for all medical causes.</p>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 9","pages":"102017"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12351332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144801169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Differences in Cardiovascular Health Status and Long-Term Outcomes in a Primary Prevention Cohort","authors":"Maneesh Sud MD, PhD ,&nbsp;Areeba Chaudhry BSc ,&nbsp;Feng Qui MSc ,&nbsp;Olivia Haldenby MSc ,&nbsp;Lucas C. Godoy MD, PhD ,&nbsp;Peter C. Austin PhD ,&nbsp;Idan Roifman MD, MSc ,&nbsp;Douglas Manuel MD, MSc ,&nbsp;Dean T. Eurich PhD, MSc, BSP ,&nbsp;Harindra C. Wijeysundera MD, PhD ,&nbsp;Mina Madan MD, MHS ,&nbsp;Thao Huynh MD, PhD ,&nbsp;Dennis T. Ko MD, MSc","doi":"10.1016/j.jacadv.2025.102108","DOIUrl":"10.1016/j.jacadv.2025.102108","url":null,"abstract":"<div><h3>Background</h3><div>Poor cardiovascular health quantified by 8 health behaviors and factors is associated with incident cardiovascular disease (CVD). However, it is not clear if this association differs between women and men.</div></div><div><h3>Objectives</h3><div>The aim of the study was to determine whether the association between cardiovascular health status and incident CVD events differs by sex.</div></div><div><h3>Methods</h3><div>Adults enrolled in the Ontario Health Study (March 2009-December 2017) with no prior CVD were included. Cardiovascular health was assessed based on the presence of ideal diet, sleep, physical activity, smoking, body habitus, blood glucose, blood cholesterol, and blood pressure. CVD events were ascertained to March 31, 2023. The association between ideal, intermediate, and poor health and outcomes was assessed using age-adjusted, cause-specific models, including interaction terms for sex.</div></div><div><h3>Results</h3><div>The cohort consisted of 175,098 individuals (61.4% women, mean age 47 years). Compared to men, more women had ideal cardiovascular health (9.1% vs 4.6%), while fewer women had poor cardiovascular health (21.9% vs 30.5%). Compared to ideal cardiovascular health, the age-adjusted HR for intermediate cardiovascular health was 2.31 (95% CI: 1.72-3.11) in women, which was greater than the HR of 1.57 (95% CI: 1.16-2.11) in men. Similarly, the HR for poor cardiovascular health was 5.08 (95% CI:3.78-6.84) in women and nearly double the HR of 2.54 (95% CI: 1.89-3.41) in men (<em>P</em> &lt; 0.01 for interaction).</div></div><div><h3>Conclusions</h3><div>In this primary prevention cohort, as cardiovascular health status declined, the relative impact on the future rate of CVD was greater for women than for men. This supports sex-specific health promotion strategies to improve health status and outcomes.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102108"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144922887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calcified Versus Noncalcified Plaque in HIV Revisited: Insights From REPRIEVE.","authors":"Alexander C Razavi, Aaron L Troy, Roger S Blumenthal","doi":"10.1016/j.jacadv.2025.102053","DOIUrl":"10.1016/j.jacadv.2025.102053","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 9","pages":"102053"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phenotypic Diversity of Marfan Syndrome.","authors":"Zixiang Xu, Zhenghong Li, Long Xiang, Tao Chen, Wang Lu, Chang'e Guo, Jinmiao Chen, Bi'ang Kang, Zesi Liu, Daokang Xiang, Liqun Sun, Kui Hu","doi":"10.1016/j.jacadv.2025.102051","DOIUrl":"10.1016/j.jacadv.2025.102051","url":null,"abstract":"<p><p>Marfan syndrome (MFS) is a genetic disorder primarily impacting the cardiovascular system, eyes, and skeletal structure, with its root cause being mutations in the FBN1 gene. The condition is notably associated with risks such as aortic aneurysm and aortic dissection, which largely drive mortality among those affected. However, the clinical presentation of MFS varies widely, and the link between specific genetic mutations and clinical symptoms is not straightforward. Although genetic testing is invaluable for diagnosing MFS, its capacity to forecast manifestations and predict patient outcomes is still limited. Thus, unraveling the underlying factors and mechanisms contributing to this phenotypic variability is crucial. Doing so can enhance genetic analysis, improving the prediction of clinical outcomes, and facilitate better risk stratification. This review provides an overview of the phenotypic diversity in MFS and underlying factors and mechanisms contributing to the phenotypic variability.</p>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 9","pages":"102051"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}