Journal of Anesthesia, Analgesia and Critical Care (Online)最新文献

{"title":"Golden hour management in the patient with intraparenchymal cerebral hemorrhage: an Italian intersociety document.","authors":"Gianluigi Morello, Daniela Alampi, Raffaele Aspide, Alessandra Beretta, Rita Bertuetti, Federico Bilotta, Etrusca Brogi, Giovanni Buscema, Anselmo Caricato, Davide Caruzzo, Carlo Alberto Castioni, Arturo Chieregato, Andrea Cortegiani, Alessandro De Cassai, Andrea Fabbri, Domenico Gelormini, Paolo Gritti, Lucrezia Guadrini, Alberto Librizzi, Nicola Latronico, Nicola Limbucci, Marina Munari, Edoardo Picetti, Giuseppina Pipitone, Gianluca Pucciarelli, Chiara Robba, Danilo Toni, Salvatore Sardo, Simone Maria Zerbi, Nicola Zugni, Frank Rasulo","doi":"10.1186/s44158-025-00244-z","DOIUrl":"https://doi.org/10.1186/s44158-025-00244-z","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous intracerebral hemorrhage (ICH) accounts for 9-27% of all strokes worldwide and is associated with high mortality and disability. The main causes include vascular malformations, small- and large-vessel angiopathies, and coagulation disorders. Mortality rates reach approximately 40% at 1 month and 54% at 1 year, largely influenced by early management decisions. Rapid intervention, particularly within the first hour, is crucial, especially for patients initially treated in peripheral hospitals. This consensus document, developed by SIAARTI with the endorsement of multiple medical societies, aims to standardize ICH management based on hospital capabilities, aligning with the \"time is brain\" principle and the 2022 AHA guidelines.</p><p><strong>Methods: </strong>A multidisciplinary panel of experts-including neurointensivists, neuroanesthesiologists, neurologists, neuroradiologists, emergency physicians, and neuroscience nurses-developed this consensus document. The process combined a systematic literature review with a modified Delphi method, prioritizing clinical questions using the UCLA-RAND appropriateness methodology. Literature searches were conducted on PubMed following PRISMA 2020 guidelines. Statements were formulated based on both evidence and expert consensus, and the final document underwent external peer review.</p><p><strong>Results: </strong>Computer tomography (CT) angiography, with over 90% sensitivity and specificity, is a key tool for identifying macrovascular abnormalities and detecting active bleeding, a critical factor in poor outcomes. Prognostic models, such as the ICH score, assist in clinical decision-making. Strict blood pressure control (target 130-140 mmHg) and early intubation in appropriate cases help mitigate hematoma expansion. Anticonvulsants are recommended only for patients with documented seizures. In cases of anticoagulant-related hemorrhage, prothrombin complex concentrates are effective for rapid reversal, though their long-term impact remains uncertain. Intensive care unit (ICU) admission is determined by ICH severity, with severe cases benefiting from specialized neurocritical care.</p><p><strong>Conclusion: </strong>A multidisciplinary and inter-societal discussion provided key recommendations for the immediate management of ICH, based on the available literature. While only a few topics are supported by robust evidence, experts strongly recommend early brain angio CT, risk stratification using scoring systems, clear communication of patient data, and intubation for impaired consciousness. Blood pressure should be controlled with alpha- and beta-blockers, avoiding hypotension. Anticoagulant reversal should be appropriately managed, and eligible patients should be centralized in ICU and neurosurgical centers using dedicated scoring systems.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"25"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060452","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":"The prognostic role of tricuspid annular plane systolic excursion in critically ill patients with septic shock.","authors":"Tamer Habib, Islam Ahmed, Rasha Abayazeed, Mina Montasser","doi":"10.1186/s44158-025-00227-0","DOIUrl":"https://doi.org/10.1186/s44158-025-00227-0","url":null,"abstract":"<p><strong>Introduction: </strong>The right ventricle (RV) may play a crucial role in predicting prognosis in critical settings. The value of the tricuspid annular plane systolic excursion (TAPSE) has been shown in the prognosis of cardiac patients, such as those with heart failure and pulmonary hypertension. The aim of this study was to evaluate the possible prognostic performance of RV dysfunction, as assessed by the TAPSE, in noncardiac septic shock patients.</p><p><strong>Methodology: </strong>One hundred critically ill adult patients diagnosed with septic shock were enrolled directly after admission. The TAPSE was measured within 24 h. Patients were analyzed according to 28-day mortality and divided into non-survivors and survivors.</p><p><strong>Results: </strong>The overall 28-day mortality rate was 62%. TAPSE showed a strong negative correlation with APACHE-II (r = - 0.569, p < 0.001) and moderately negatively correlated with the SOFA score (r = - 0.448, p = 0.001). TAPSE (at a cutoff point of 2 cm) was a very good tool (area under curve = 0.887) for predicting 28-day mortality (95% confidence interval CI 0.770-0.980, p < 0.0001).</p><p><strong>Conclusion: </strong>Early echocardiographic assessment of RV dysfunction to measure TAPSE might be of prognostic importance in noncardiac patients with septic shock, as a TAPSE less than 2 cm was useful for predicting poor outcomes.</p><p><strong>Trial registration: </strong>clinicaltrials.gov, NCT06008067. Registered 18 July 2023 registered. TAPSESEPTIC study.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"24"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059249","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":"Role of liposomal amphotericin B in intensive care unit: an expert opinion paper.","authors":"Linda Bussini, Michele Bartoletti, Matteo Bassetti, Andrea Cortegiani, Gennaro De Pascale, Francesco Giuseppe De Rosa, Marco Falcone, Maddalena Giannella, Massimo Girardis, Paolo Grossi, Malgorzata Mikulska, Paolo Navalesi, Federico Pea, Maurizio Sanguinetti, Carlo Tascini, Bruno Viaggi, Pierluigi Viale","doi":"10.1186/s44158-025-00236-z","DOIUrl":"https://doi.org/10.1186/s44158-025-00236-z","url":null,"abstract":"<p><strong>Introduction: </strong>Invasive fungal infections (IFI) are frequent in patients admitted to the intensive care unit (ICU). The use of first-line antifungals like triazoles or echinocandins may be limited by the global spread of multi-drug resistance species, drug-drug interactions, low organ penetration, and some safety concerns in case of multi-organ failure. Liposomal amphotericin B (L-AmB) is a polyene drug with a broad activity against mold and yeast and an acceptable safety profile. To outline the role of L-AmB in the treatment of IFI in critically ill patients, a panel of experts was invited to draw up an expert opinion paper on the appropriate place in therapy of L-AmB in different clinical scenarios of patients admitted to ICU.</p><p><strong>Methods: </strong>A multidisciplinary group of 16 specialists in infectious disease, microbiology, pharmacology, and intensive care elaborated an expert opinion document through a multi-step approach: (1) the scientific panel defined the items and wrote the statements on the management of IFI in ICU, (2) a survey was submitted to an external panel to express agreement or disagreement on the statements, and (3) the panel reviewed the survey and implemented the final document.</p><p><strong>Results: </strong>The final document included 35 statements that focused on epidemiology and microbiological rationale of the use of systemic L-AmB in critically ill patients and its potential role in specific clinical scenarios in the ICU.</p><p><strong>Conclusion: </strong>Systemic L-AmB may represent an appropriate therapeutic choice for IFI in ICU patients with different underlying conditions, especially when the use of first-line agents is undermined. This expert opinion paper may provide a useful guide for clinicians.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"23"},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060457","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":"The snake's skin: fibroblastic sheath after veno-venous ECMO?","authors":"Francesco Alessandri, Antonella Tosi, Francesco Pugliese","doi":"10.1186/s44158-025-00240-3","DOIUrl":"https://doi.org/10.1186/s44158-025-00240-3","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"22"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043395","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":"Protein C in adult patients with sepsis: from pathophysiology to monitoring and supplementation.","authors":"Irene Coloretti, Antonio Corcione, Gennaro De Pascale, Abele Donati, Francesco Forfori, Marco Marietta, Mauro Panigada, Paolo Simioni, Carlo Tascini, Pierluigi Viale, Massimo Girardis","doi":"10.1186/s44158-025-00243-0","DOIUrl":"https://doi.org/10.1186/s44158-025-00243-0","url":null,"abstract":"<p><p>Protein C (PC) plays a crucial role in modulating inflammation and coagulation in sepsis. Its anticoagulant and cytoprotective properties are critical in mitigating sepsis-induced coagulopathy, which is associated with high mortality rates. In sepsis, low levels of PC are associated with an elevated risk of multiple organ dysfunction and increased mortality. Routine monitoring of PC levels is not widely implemented but appears relevant in selected populations, such as patients with purpura fulminans, sepsis-induced coagulopathy (SIC), disseminated intravascular coagulopathy (DIC) or hyperinflammatory septic shock phenotypes. Treatment with PC has been limited to PC concentrate approved for paediatric use in congenital PC deficiencies and purpura fulminans, while the efficacy of PC supplementation in sepsis remains a subject of debate. Considering the physiological significance of PC and its role in sepsis pathophysiology, additional studies are necessary to fully elucidate its therapeutic efficacy in specific clinical settings.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"21"},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11998338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022523","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":"Planning intensive care unit admission after elective major abdominal surgery: good clinical practice document by SIAARTI-SIC-ANIARTI.","authors":"Bruna Lavezzo, Giandomenico Biancofiore, Ersilia Luca, Roberto Balagna, Elena Bignami, Ugo Boggi, Rita Cataldo, Giuseppe Chiaramonte, Andrea Cortegiani, Umberto Fiandra, Roberta Mariani, Matteo Manici, Alessia Mattei, Liliana Sollazzi, Luigi Tritapepe, Martina Tosi, Stefano Turi, Mauro Zago, Paola Aceto","doi":"10.1186/s44158-025-00239-w","DOIUrl":"https://doi.org/10.1186/s44158-025-00239-w","url":null,"abstract":"<p><p>Postoperative complications (PCs) are a major cause of mortality following elective major abdominal surgery (EMAS). The increasing complexity of abdominal procedures, particularly in oncology, may significantly affect patient outcomes. However, this has also introduced a higher variability in postoperative management, and the use of tailored approaches to address critical issues such as hemodynamic stabilization, infection management, and respiratory failure. While elective admission to intensive care units (ICU) is a standard practice to manage high-risk surgical patients, ICU resource allocation is often influenced by local practices and bed availability.This document presents a framework for preoperative ICU admission planning after EMAS. It focuses on the identification of patient and surgical risk factors-using established scoring systems-and provides statements to determine ICU admission. The aim is to optimize resource allocation, reduce PCs, and prevent unplanned ICU admissions. This good clinical practice statement was developed through a multidisciplinary panel formed by selected members coming from SIAARTI (Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care), SIC (Italian Society of Surgery) and ANIARTI (National Association of Critical Area Nurses).The designed scientific board developed, through a systematic literature review and a consensus methodology, a roadmap for defining the priorities of perioperative care based on the complexity of the patient and the surgical procedure. Eventually, the panel worked out statements about six voted queries that could have supported the preoperative indication to postoperative ICU admission.Evaluation of patients' characteristics, comorbidities, and surgical factors are all essential to plan ICU admission for immediate postoperative patient care after EMAS.The presence and severity of comorbidities, assessed through various severity scores, play a crucial role in predicting PCs and guiding ICU admission decisions. Tools such as the American Society of Anesthesiologists physical status, Charlson Comorbidity Index, and Rockwood Frailty Index, along with surgical risk scores and intraoperative events, help define the need for intensive care. Preoperative frailty assessment-achieved using the Clinical Frailty Scale-is essential to anticipate postoperative care needs. Finally, during the postoperative phase, continuous monitoring and reassessment in the post-anesthesia care unit are key to determine whether ICU admission is required. Establishing high-dependency units and tailored care pathways based on individual patient needs and available resources will enhance patient outcomes and optimize postoperative care.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"20"},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044719","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":"Pediatric head trauma algorithm for head CT decision-making in the emergency department.","authors":"Gabriele Savioli, Iride Francesca Ceresa, Andrea Piccioni, Yaroslava Longhitano, Raymond Planinsic, Michele Dorfsman, Antonio Voza, Federica Manzoni, Giorgia Caputo, Abdelouahab Bellou, Luigi La Via, Christian Zanza","doi":"10.1186/s44158-025-00238-x","DOIUrl":"https://doi.org/10.1186/s44158-025-00238-x","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury is a common cause of admission in Emergency Department (ED) for pediatric patients. The aim of this study was to evaluate the application of the Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) algorithm in ED for head CT decision-making in pediatric patients. The secondary objective was to evaluate the impact of adherence to this protocol on ED crowding, length of stay, and boarding time.</p><p><strong>Methods: </strong>We conducted a retrospective study including children aged ≤ 15 years who were admitted in a level 2 trauma center ED for mild TBI from 1 January 2016 to 31 December 2019. Collected data included amnesia, symptoms, demographics, outcomes, length of ED stay, the patient's outcomes, including intracranial injuries (ICI) and injuries requiring neurosurgery.</p><p><strong>Results: </strong>A total of 1372 children with mild TBI were included. More than half of the patients were male (59.8%) and ≥ 2 years of age (63.2%). Most of the trauma events (58%) were caused by home injury. Neurosurgical consultation (59.4%) was the most common intervention in the ED. Only 4.3% of patients required neuroimaging and 7 children had intracranial hemorrhage, with only 1 requiring immediate neurosurgical intervention. There were no re-admissions for bleeding. The adoption of this protocol had no negative impact on crowding, and a reduction of ED length of stay.</p><p><strong>Conclusions: </strong>The adoption of the PECARNE algorithm led to fewer brain computed tomography scans with good clinical outcomes without increasing crowding.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"19"},"PeriodicalIF":0.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11983826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059974","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":"Methodological limitations in acceleromyographic monitoring: a comment on the study by Piccioni et al.","authors":"Mustafa Büyükcavlak","doi":"10.1186/s44158-025-00242-1","DOIUrl":"https://doi.org/10.1186/s44158-025-00242-1","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"18"},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032164","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":"Catecholamines in sepsis: pharmacological insights and clinical applications-a narrative review.","authors":"Jacopo Belfiore, Riccardo Taddei, Giandomenico Biancofiore","doi":"10.1186/s44158-025-00241-2","DOIUrl":"10.1186/s44158-025-00241-2","url":null,"abstract":"<p><p>Catecholamines, essential neurotransmitters and hormones, play a critical role in the body's physiological response to stress and are pivotal in the management of various clinical conditions, particularly in critical care settings. This narrative review delves into the pharmacological properties of catecholamines, including their mechanisms of action, pharmacokinetics, and pharmacodynamics. Key clinical applications of catecholamines, especially in the cardiovascular and immune systems, are highlighted, emphasizing their roles in modulating heart rate, vascular tone, and immune responses during critical conditions such as sepsis and septic shock. Additionally, the review explores catecholamines' immunomodulatory effects and their interactions with other therapeutic agents, such as corticosteroids, in the management of septic shock. Further research is suggested to optimize catecholamine usage and improve patient outcomes in critical care settings.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"17"},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774754","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":"A narrative review of glucagon-like peptide-1 receptor agonists prior to deep sedation or general anesthesia.","authors":"Luigi Vetrugno, Cristian Deana, Andrea Da Porto, Enrico Boero, Valentina Bellini, Daniele Guerino Biasucci, Elena Giovanna Bignami","doi":"10.1186/s44158-025-00237-y","DOIUrl":"10.1186/s44158-025-00237-y","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists are a class of drugs that mimic a natural incretin hormone released by the intestine after meals, and they are well-suited for treating type 2 diabetes. Glucagon-like peptide-1 receptor agonists also lead to satiety and appetite reduction through action on the brain's appetite regulation centers, leading to weight loss in obese patients. However, because glucagon-like peptide-1 receptor agonists work to slow gastric emptying, a safety concern has been raised in patients undergoing deep sedation or general anesthesia regarding gastric aspiration, and considering their long half-life in the blood, they are difficult to manage in the perioperative period. The purpose of this review is (i) to explore the present knowledge about the risk of aspiration before anesthesia; (ii) to describe the method for evaluating the presence of liquid and food in the stomach before surgery; and (iii) to balance the actual warning with the opportunity for future discovery about their benefits.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"16"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744465","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}