JTCVS open最新文献

{"title":"Commentator Discussion: Acute loss of mitral annular dynamics predicts development of functional mitral regurgitation after myocardial infarction in a swine model","authors":"","doi":"10.1016/j.xjon.2025.03.004","DOIUrl":"10.1016/j.xjon.2025.03.004","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 70-71"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320940","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":"Extracorporeal membrane oxygenation as a bridge to lung transplant for patients with interstitial lung disease: An international survey study","authors":"Anil J. Trindade MD , Whitney D. Gannon MS, MSN , John W. Stokes MD , Emily A. Vail MD, MSc , Cara Agerstrand MD , Mauer Biscotti III MD , Sarah L. Bloom DNP, AGACNP , Caitlin T. Demarest MD, PhD , Matthew Bacchetta MD, MBA , Konrad Hoetzenecker MD, PhD","doi":"10.1016/j.xjon.2025.03.014","DOIUrl":"10.1016/j.xjon.2025.03.014","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 474-484"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321418","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":"In situ gastroepiploic artery versus I-composite right internal thoracic artery radial artery for severe right coronary artery stenosis in off-pump coronary artery bypass grafting","authors":"Hideki Isa MD ,&nbsp;Ryohei Ushioda MD ,&nbsp;Baku Takahashi MD, PhD ,&nbsp;Dit Yoongtong MD ,&nbsp;Boonsap Sakboon MD ,&nbsp;Jaroen Cheewinmethasiri MD ,&nbsp;Hiroyuki Kamiya MD, PhD ,&nbsp;Nuttapon Arayawudhikul MD","doi":"10.1016/j.xjon.2025.04.009","DOIUrl":"10.1016/j.xjon.2025.04.009","url":null,"abstract":"<div><h3>Objective</h3><div>This study compared the I-composite graft comprising the right internal thoracic artery and radial artery with the gastroepiploic artery in off-pump coronary artery bypass grafting for severe right coronary artery stenosis.</div></div><div><h3>Methods</h3><div>This study included 78 and 141 patients who underwent right internal thoracic artery-radial artery and gastroepiploic artery grafting, respectively, for off-pump coronary artery bypass grafting between April 2011 and June 2024. Propensity score matching was conducted, and postoperative outpatient follow-up was performed.</div></div><div><h3>Results</h3><div>Propensity score matching resulted in 65 patients in each group. Preoperative characteristics, operative time, and the number of arterial revascularizations and distal anastomoses did not differ significantly between the groups. However, more graft conduits were used in the right internal thoracic artery-radial artery group. Short-term postoperative outcomes were similar, except for a significantly higher early extubation rate in the right internal thoracic artery-radial artery group. During a median follow-up of 5.0 years, overall survival did not differ significantly between the groups. However, the gastroepiploic artery group had a significantly lower long-term freedom from major adverse cardiac and cerebrovascular events, particularly heart failure requiring hospitalization. Multivariate analysis identified a history of peripheral arterial disease as a significant risk factor for overall mortality, whereas the type of right coronary artery graft was not.</div></div><div><h3>Conclusions</h3><div>Using the gastroepiploic artery as a direct conduit for severe right coronary artery stenosis appears to be a promising option when selecting an arterial graft, particularly in improving major adverse cardiac or cerebrovascular events-free survival.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 134-142"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320870","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":"Evolution over time of aortic root anatomy after aortic valve reimplantation","authors":"Francesco Giosuè Irace MD, PhD ,&nbsp;Giulio Folino MD ,&nbsp;Ilaria Chirichilli MD ,&nbsp;Andrea Salica MD ,&nbsp;Raffaele Scaffa MD ,&nbsp;Luca Paolo Weltert MD ,&nbsp;Ruggero De Paulis MD, PhD","doi":"10.1016/j.xjon.2025.04.007","DOIUrl":"10.1016/j.xjon.2025.04.007","url":null,"abstract":"<div><h3>Objective</h3><div>Restoring the anatomic relationships among the aortic root components is important to achieve durable valve competence. We previously analyzed the in vivo anatomy of the aortic root after reimplantation with the Valsalva graft. This study aims to evaluate if the topographic relationship among the neoroot components varies over time.</div></div><div><h3>Methods</h3><div>Ten patients underwent a reimplantation procedure with the Valsalva graft. Surgical hemoclips were applied as radiopaque markers at the base of the annular knots and at the reimplanted commissures. All patients underwent a cardiac computed tomography scan at discharge (T0) and at follow-up (T1). Aortic root features were measured in both series. The annular dimensions and the distances between the annular hemoclips and the virtual basal ring—as height from the annular plane and as distance from the annular lumen—were measured, and compared at T0 and T1.</div></div><div><h3>Results</h3><div>The mean follow-up time was 50 ± 4 months. There were no deaths, reoperations, or recurrent aortic regurgitation. Postoperative (T0) versus follow-up (T1) measures showed no significant differences in annular dimensions. The mean heights of polyethylene terephthalate graft basal landmarks and planar distance from virtual basal ring were also not significantly modified over time.</div></div><div><h3>Conclusions</h3><div>After a mean of 4 years of follow-up, no significant modification of the relationships among aortic root components occurred. The proximal edge of the polyethylene terephthalate graft lies at the ventricular-arterial junction at a slightly different thickness and height along the annular circumference, especially at the level of right sinus and left-right commissure. This feature persists at follow-up.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 39-44"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321020","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":"Implications of tracheostomy after acute type A aortic dissection repair: Longitudinal outcomes and factors associated with patients requiring it","authors":"Carlos E. Diaz-Castrillon MD ,&nbsp;Derek Serna-Gallegos MD ,&nbsp;Shwetabh Tarun BA ,&nbsp;Pyongsoo Yoon MD ,&nbsp;Johannes Bonatti MD ,&nbsp;Danny Chu MD ,&nbsp;David Kaczorowski MD ,&nbsp;Francis D. Ferdinand MD ,&nbsp;Jianhui Zhu PhD ,&nbsp;Julie Phillippi PhD ,&nbsp;Floyd Thoma BS ,&nbsp;Danial Ahmad MD ,&nbsp;Ibrahim Sultan MD","doi":"10.1016/j.xjon.2025.02.018","DOIUrl":"10.1016/j.xjon.2025.02.018","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze the factors associated with the need for tracheostomy after surgical repair of acute type A aortic dissection (ATAAD) and its implications for longitudinal outcomes.</div></div><div><h3>Methods</h3><div>This retrospective analysis of patients who underwent ATAAD repair from 2010 to 2020 focused on a comparison of patients who required a tracheostomy versus those who did not. Adjusted regression analysis and a classification and regression tree (CART) model were used to assess factors influencing the need for tracheostomy and its association with longitudinal survival.</div></div><div><h3>Results</h3><div>Fifty-two of the 552 patients in the study cohort (9.4%) required a tracheostomy, performed at a median of 12 days after ATAAD repair (interquartile range [IQR], 8-17 days). The CART analysis identified the number of reintubations and the duration of initial mechanical ventilation as key predictors of tracheostomy, with subgroups showing tracheostomy rates ranging from 7% to 100%. Nearly one-half of the patients had their tracheostomy removed successfully, with a median time to removal of 33 days (IQR, 17-67 days). Compared to nontracheostomized patients, tracheostomized patients had a higher 1-year readmission rate (44.23% vs 29.58%; <em>P</em> = .03), including in the intensive care unit setting (34.62% vs 16.10%; <em>P</em> &lt; .001). They also had significantly lower survival rates at 1 year (77.8% vs 95.3%; <em>P</em> &lt; .001), 5 years (62.1% vs 86.1%; <em>P</em> &lt; .001), and 10 years (43.2% vs 73.5%; <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Tracheostomy is associated with significant longitudinal mortality and readmissions after ATAAD repair. The CART model highlights the relevance of reintubation for clinical decision making. Improved predictive models may enable early interventions, which could mitigate the effects of prolonged mechanical ventilation and improve resource utilization. Future research should focus on refining these models and assessing postoperative rehabilitation programs.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 1-9"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321017","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":"Global surgery interest and engagement in Canadian thoracic surgery practice","authors":"Roy A. Hilzenrat MD, MHSc, MGSC ,&nbsp;Adom Bondzi-Simpson MD, MSc ,&nbsp;Caroline Huynh MD, FRCSC ,&nbsp;Michael Ko MD, PhD, FRCSC ,&nbsp;Ahmad S. Ashrafi MD, FRCSC","doi":"10.1016/j.xjon.2025.03.020","DOIUrl":"10.1016/j.xjon.2025.03.020","url":null,"abstract":"<div><h3>Objective</h3><div>Thoracic pathologies pose a substantial health burden in low- and middle-income countries. Compounding the high incidence of these conditions, a global shortage and unequal distribution of surgical professionals exacerbate morbidity, mortality, and disability-adjusted life years in these regions. Global thoracic surgery aims to address these disparities. This study explores the interest, engagement, and perceived importance of global surgical care among Canadian thoracic surgeons.</div></div><div><h3>Methods</h3><div>A self-administered electronic survey was distributed to members of the Canadian Association of Thoracic Surgery. The survey assessed perceptions of global surgery, willingness to engage in international collaborations, institutional resources, and barriers to participation.</div></div><div><h3>Results</h3><div>Thirty-three practicing thoracic surgeons participated, most of whom worked in academic centers (23 out of 33 [69.7%]). A majority (30 out of 33 [90.9%]) believed international collaboration enhances thoracic surgery. Although 48.5% (16 out of 33) were willing to travel abroad to support surgical capacity in low- and middle-income countries, and an equal percentage expressed interest in research addressing low- and middle-income countries’ needs, only 21.2% (7 out of 33) had prior involvement in global thoracic surgery. Key barriers included a lack of institutional support (26 out of 33 [78.8%]), limited formal collaborative opportunities (26 out of 33 [78.8%]), inadequate funding (30 out of 33 [90.9%]), and an absence of recognized pathways for career development in global surgery (29 out of 33 [87.9%]).</div></div><div><h3>Conclusions</h3><div>Canadian thoracic surgeons have a keen interest in global surgical initiatives; however, they face significant barriers in institutional support, resources, and accessibility of collaborative opportunities. Tackling these challenges through strengthened institutional policies, directed funding, and the establishment of a dedicated national network may enhance engagement in global thoracic surgical care.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 501-509"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321421","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":"Transplantation of vascularized cardiac microtissue from human induced pluripotent stem cells improves impaired electrical conduction in a porcine myocardial injury model","authors":"Yuki Kuroda MD ,&nbsp;Jun Iida MD ,&nbsp;Kozue Murata PhD ,&nbsp;Yuki Hori MD ,&nbsp;Jumpei Kobiki MD ,&nbsp;Kenji Minatoya MD, PhD ,&nbsp;Hidetoshi Masumoto MD, PhD","doi":"10.1016/j.xjon.2025.03.006","DOIUrl":"10.1016/j.xjon.2025.03.006","url":null,"abstract":"<div><h3>Objective</h3><div>To demonstrate that the transplantation of human induced pluripotent stem cell (hiPSC)-derived vascularized cardiac microtissue (VCM) can improve conduction disturbances after myocardial injury (MI).</div></div><div><h3>Methods</h3><div>We prepared cell sheet-shaped VCM with hiPSC-derived cardiomyocytes and vascular cells using dynamic rocking culture. We induced MI via epicardial cryoablation in immunosuppressed crown minipigs (VCM and sham groups; n = 3) and transplanted the VCMs immediately after MI induction. The pigs underwent epicardial electroanatomical mapping immediately before and 1 week after MI induction.</div></div><div><h3>Results</h3><div>One week after MI induction, mean electrical potentials at the MI site decreased in both groups during sinus rhythm (from 11.05 to 1.74 mV in the VCM group and from 8.72 to 2.70 mV in the sham group, <em>P</em> = .048). The mean conduction velocity between the remote and MI sites was numerically higher in the VCM group compared with the Sham group (2.84 m/s vs 1.74 m/s). One of the 3 animals in the VCM group demonstrated 2 independent origins of excitation corresponding to the pacing sites when simultaneous pacing of the remote and MI sites was performed 1 week after MI induction. Histologic examination confirmed that the VCM had engrafted on the surface of the MI region. Furthermore, we confirmed that the myocardial tissue in the MI region remained more intact one week after injury in the VCM transplantation group compared to the sham group, suggesting that this contributed to the reduction of conduction disturbances.</div></div><div><h3>Conclusions</h3><div>The transplantation of VCM demonstrated a potential for improving conduction disturbances in MI.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 154-162"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321710","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":"Influences of age and obesity on heart transplant outcomes","authors":"Zach Rollins MD ,&nbsp;Ye In Christopher Kwon BA ,&nbsp;Graham Gardner MD ,&nbsp;Elizabeth Bashian MD ,&nbsp;Matthew Ambrosio MS ,&nbsp;Inna F. Tchoukina MD ,&nbsp;Keyur Shah MD ,&nbsp;Rahul Rajeev MD ,&nbsp;Josue Chery MD ,&nbsp;Vigneshwar Kasirajan MD ,&nbsp;Zubair A. Hashmi MD","doi":"10.1016/j.xjon.2025.02.022","DOIUrl":"10.1016/j.xjon.2025.02.022","url":null,"abstract":"<div><h3>Objective</h3><div>Obesity and older age have both been identified as risk factors for a worse long-term prognosis after heart transplantation. We sought to determine the 5-year outcomes for heart transplant patients with high-risk body mass index (BMI) &gt;30 (HRB), high-risk age &gt;70 years (HRA), or both (HRAB) as compared with recipients with normal risk (NR) in the modern era.</div></div><div><h3>Methods</h3><div>Records of isolated heart transplants in the United States from 2014 to 2023 were obtained for adults older than 18 years. BMI and age cut-off was identified on spline analysis. Survival curves were built for overall survival using a Kaplan-Meier method, with a log-rank test used to test for differences between groups. Risk adjusted Cox regression was performed on variables potentially influencing overall survival.</div></div><div><h3>Results</h3><div>Between 2014 and 2023, there were 15,839 NR; 869 HRA; 8187 HRB; and 202 HRAB patients. There was a significant difference in overall survival by Kaplan-Meier evaluation between the 4 groups, with worse survival in the high-risk groups (<em>P</em> &lt; .001). The hazard ratio for mortality in the HRB, HRA, and HRAB groups was 1.21, 1.23, and 1.72, respectively (<em>P</em> &lt; .05). However, even recipients in the HRAB group had 5-year survival rates of 66.8%.</div></div><div><h3>Conclusions</h3><div>Overall survival is worse in recipients in the HRA, HRB, or HRAB groups than in recipients in the NR group but similar between patients with isolated BMI &gt;30 or age &gt;70 years. Patients with both increased BMI &gt;30 and age &gt;70 years had the worst overall survival. However, the 5-year survival even for HRAB suggests the value of transplantation even if patients are at high risk.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 253-263"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320955","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":"Commentator Discussion: Influence of mitral regurgitation reduction on uncorrected tricuspid regurgitation after left ventricular assist device implantation","authors":"","doi":"10.1016/j.xjon.2025.03.002","DOIUrl":"10.1016/j.xjon.2025.03.002","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 225-226"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321655","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":"The influence of initial Norwood palliation on cardiac transplantation in the failing Fontan: A dual-institution study","authors":"Ryan G. McQueen BS, MA ,&nbsp;Danielle I. Aronowitz MD, MS ,&nbsp;Nikki M. Singh MD ,&nbsp;Ruta Brazauskas PhD ,&nbsp;Danielle Burstein MD ,&nbsp;Rachel M. White BSN, RN, CCTC ,&nbsp;Stephanie Fuller MD, MS ,&nbsp;J. William Gaynor MD ,&nbsp;Ronald K. Woods MD, PhD","doi":"10.1016/j.xjon.2025.02.003","DOIUrl":"10.1016/j.xjon.2025.02.003","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the differences in perioperative cardiac transplant courses and outcomes between patients with failed Fontan physiology who initially underwent a Norwood procedure and those who did not.</div></div><div><h3>Methods</h3><div>A retrospective review of 78 cardiac transplant patients with failed Fontan physiology from 1994 to 2021 was conducted; 42 had a previous Norwood procedure (FFN) and 36 did not (FF).</div></div><div><h3>Results</h3><div>Although patients in the FFN group appeared to have a more complex perioperative course, they experienced better discharge and 1-year survival compared with patients in the FF group: discharge survival of 81% of patients in the FFN group compared with 75% of patients in the FF group (<em>P</em> = .5256); 1-year survival of 80.5% of patients in the FFN group compared with 73.5% of patients in the FF group (<em>P</em> = .4737). Notable trends in the perioperative courses of the FFN cohort compared with the FF cohort included: more frequent neoaortic reconstruction at the time of transplant (7 patients in the FFN group [16.7%] vs 1 patient in the FF group [2.8%], <em>P</em> = .0627), greater rate of sternal re-entry events (5 patients in the FFN group [11.9%] vs 2 patients in the FF group [5.7%], <em>P</em> = .4454), longer median duration of surgery (FFN 611.5 minutes vs FF 556 minutes, <em>P</em> = .3928), longer median cardiopulmonary bypass times (FFN 222.5 minutes vs FF 202 minutes, <em>P</em> = .1584), more use of open sternal management (14 patients in the FFN group [33.3%] vs 7 patients in the FF group [20%], <em>P</em> = .1908), and longer median length of hospital stay (FFN 41 days vs FF 30 days, <em>P</em> = .4035).</div></div><div><h3>Conclusions</h3><div>Despite patients in the FFN group exhibiting a more complex operative and perioperative course, discharge and 1-year survival were better than those of patients in the FF group.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 346-353"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320929","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}