Journal of clinical medicine research最新文献

{"title":"What We Do and What We Should Do Against Malnutrition in Spinal Cord Injury: A Position Paper From Italian Spinal Cord Injury Network Rehabilitation Centers.","authors":"Alessandra Areni, William Capeci, Adriana Cassinis, Luisa De Palma, Giulio Del Popolo, Florinda Fergnani, Laura Pelizzari","doi":"10.14740/jocmr5015","DOIUrl":"10.14740/jocmr5015","url":null,"abstract":"<p><p>Spinal cord injury (SCI) is a traumatic event that significantly impacts body composition and alters energy and nutritional needs. This places patients with SCI at a high risk of malnutrition, which can hinder optimal functional recovery, prolong hospital stays, increase hospital admissions, and contribute to the development of obesity and cardiovascular and metabolic ailments in chronic patients. Consequently, there is an urgent need for clear guidance to support clinicians in managing the nutritional needs of patients with SCI at different stages of the disease, including the acute (0 - 4 months after injury), post-acute (4 - 26 months after injury), and post-discharge phases. This study utilized a cross-sectional survey to assess the strategies employed in seven spinal units across Italy to address the nutritional needs of patients with SCI during the acute, post-acute, and post-discharge phases of the condition. Eight clinicians (five physiatrists, two internists, and one urologist) and one nurse participated in the survey. Following the survey completion, the participants were invited to partake in a round table session to delve deeper into the questionnaire results to gather their opinions and gain insights into clinical practices related to the various challenges surrounding the management of malnutrition in patients with SCI. We here review the available evidence on the energy needs and nutritional requirements of patients with SCI, highlighting the clinical aspects that deserve more attention throughout the distinct phases of the disease. We additionally provide an overview of the scenario regarding the management of malnutrition in patients with SCI across various spinal units in Italy. Through this comprehensive analysis, we aimed to enhance understanding and provide valuable insights for clinicians working with patients with SCI, equipping them with the knowledge and confidence to provide nutritional support to patients with SCI efficiently. By addressing the challenges of defining nutritional needs and presenting a practical guide, we aspire to contribute to the overall management and care of individuals with SCI and the prevention of malnutrition and its associated complications, thereby improving patient outcomes.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 4","pages":"138-154"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140878412","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":"Successful Implementation of Combined Treatment Methods for a Rare Recurrence of Waldenstrom Macroglobulinemia With Extramedullary Lesions.","authors":"Irina Yakovlevna Sokolova, Sabina Maximovna Sokolova, Olga Valentinovna Bochkarnikova, Ayshat Eldarovna Rasulova, Timur Raisovich Izmailov, Pavel Vladimirovich Polushkin, Yulia Yurevna Kirichenko, Yuriy Nikitich Belenkov, Irina Sergeevna Ilgisonis","doi":"10.14740/jocmr5115","DOIUrl":"10.14740/jocmr5115","url":null,"abstract":"<p><p>A 67-year-old woman was admitted to the Hematology Department in 2014 with complaints of weakness and a low-grade fever. After conducting various tests, it was confirmed that she had Waldenstrom macroglobulinemia. She underwent several rounds of chemotherapy and maintenance therapy with rituximab, which resulted in a good clinical response. However, in 2019, an abnormal growth in the soft tissues of patient's frontal region was discovered, which was diagnosed as lymphoplasmacytic lymphoma. This later progressed to an intracranial lesion. The patient underwent radiation therapy for both the extramedullary and intracranial growths, which had a positive effect. A year later, she developed a lesion in her lymph nodes and soft tissues of her right leg, which was confirmed to be a recurrence of Waldenstrom disease. She underwent further treatment and is currently in complete remission. This case highlights the rare occurrence of relapse in Waldenstrom disease and the challenges in diagnosing extramedullary lesions. It also demonstrates the success of modern treatment approaches using a combination of therapies.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 4","pages":"189-195"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140878339","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 Utility of Echocardiography in Estimating Fluid Responsiveness.","authors":"Nnedindu Asogwa, Marc Assaad, Joanne Ling, Gennifer Wahbah Makhoul, Halim El Hage","doi":"10.14740/jocmr5114","DOIUrl":"10.14740/jocmr5114","url":null,"abstract":"<p><p>Assessing the volume status in critically ill patients is the key to maintain the stability of the hemodynamics; however, it can be challenging to view the complexity of cases and the diversity of shock etiology. Multiple noninvasive means have been used to study the effectiveness of volume resuscitation, but none of them have been used as gold standard. We aim to illustrate the most used techniques: left ventricular outflow tract velocity time integral versus inferior vena cava compressibility index, and highlight their limitations and strengths. These tools are both operator-dependent and might be affected by several factors including ventilator settings.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 4","pages":"129-132"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140878341","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":"Investigator-Initiated vs. Investigator-Sponsored Research: Definitions Matter.","authors":"Elli Gourna Paleoudis, Cheryl Pinto","doi":"10.14740/jocmr5090","DOIUrl":"https://doi.org/10.14740/jocmr5090","url":null,"abstract":"","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 1","pages":"31-32"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10846485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139704398","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":"Cold Agglutinin Disease and COVID-19: A Scoping Review of Treatments and Outcomes.","authors":"Jackson S Musuuza, Silpa Kumar, Dheeraj Kumar Posa, Aakash Hans, Sankett Nayyar, Leslie Christensen, Gilbert-Roy Kamoga","doi":"10.14740/jocmr5102","DOIUrl":"10.14740/jocmr5102","url":null,"abstract":"<p><strong>Background: </strong>Reports suggest that patients with both acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and cold agglutinin disease (CAD) may experience poorer survival when treated with rituximab. We conducted a scoping review to evaluate severe outcomes, including intensive care unit (ICU) admission and mortality, in coronavirus disease 2019 (COVID-19) patients with CAD on various treatments, including rituximab.</p><p><strong>Methods: </strong>This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Four literature databases were searched on December 19, 2023, for studies reporting lab-confirmed SARS-CoV-2 and CAD, excluding rheumatological conditions.</p><p><strong>Results: </strong>Of the 741 screened articles, 19 were included. Studies, predominantly case reports (17/19) or case series (2/19), were mainly from the USA (8/19) and India (3/19), with others across Europe and Asia. Among 23 patients (61% female, median age 61 years), 21/23 had a new CAD diagnosis; only two had pre-existing CAD. Overall, 74% recovered, 21% died, and outcomes for one were unreported. Nine (39%) were ICU-admitted. Of rituximab-treated patients (n = 4), 25% were ICU-admitted, none died. Non-rituximab treatments (n = 19) saw 42% ICU admissions and 26% mortality.</p><p><strong>Conclusions: </strong>This review found no increased risk of severe outcomes in CAD and COVID-19 patients treated with rituximab.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 1","pages":"8-14"},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10846489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139704396","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":"Use of a Novel Buffered Hypertonic Saline Solution for Fluid Replacement and Resuscitation During Spinal Surgery in Adolescents.","authors":"Maria Lysandrou, Julie Rice-Weimer, Sibelle Aurelie Yemele Kitio, Islam Elmitwalli, Allen Kadado, Walter Samora, Marco Corridore, Joseph D Tobias","doi":"10.14740/jocmr5059","DOIUrl":"10.14740/jocmr5059","url":null,"abstract":"<p><strong>Background: </strong>During major orthopedic procedures, such as posterior spinal fusion (PSF), isotonic fluids, colloids, starches, or gelatins are commonly used to replace the preoperative fluid deficit and provide ongoing fluid resuscitation. Given recent concerns regarding the potential adverse physiologic effects of albumin solutions, we have modified our intraoperative practice to include the use of a novel 2% buffered hypertonic saline solution during major orthopedic procedures. We present our preliminary clinical experience with this novel fluid for intraoperative resuscitation and its impact on limiting the use of 5% albumin.</p><p><strong>Methods: </strong>A retrospective review was performed to identify patients who received 2% buffered hypertonic saline during PSF. The intraoperative course of these patients was compared to case-matched control patients who received standard care with isotonic fluids plus 5% albumin as an adjunct for intravascular resuscitation.</p><p><strong>Results: </strong>The study cohort included 23 patients who received 2% buffered hypertonic saline and 25 in the case-matched control group. There was no difference in the volume of intraoperative isotonic crystalloid fluids, estimated blood loss, and urine output between the two groups. In the control cohort, 19 of 25 patients (76%) received 5% albumin compared to only six of 23 patients (26%, P = 0.0005) in the 2% buffered hypertonic saline group. The final pH was higher in the patients that received 2% buffered hypertonic saline than in the control group (7.40 ± 0.03 versus 7.36 ± 0.06, P = 0.0131). Additionally, the starting and final serum sodium values were higher in the patients that received 2% buffered hypertonic saline, although no difference was noted in the mean change from the starting value (average increase of 2 mEq/L in both groups).</p><p><strong>Conclusion: </strong>Use of a novel 2% buffered hypertonic saline solution for intraoperative resuscitation during major orthopedic procedures decreases the need for 5% albumin while avoiding the development of hyperchloremic metabolic acidosis which may occur with standard sodium chloride solutions.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10846487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139704400","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":"Intubation Time, Lung Mechanics and Outcome in COVID-19 Patients Suffering Acute Respiratory Distress Syndrome: A Single-Center Study.","authors":"Diamanto Aretha, Sotiria Kefala, Alexandra Nikolopoulou, Vasilios Karamouzos, Maria Valta, Virginia Mplani, Alexandra Georgakopoulou, Chrysavgi Papamichail, Christina Sklavou, Fotini Fligou","doi":"10.14740/jocmr4984","DOIUrl":"10.14740/jocmr4984","url":null,"abstract":"<p><strong>Background: </strong>We examined the effect of intubation time and the lung mechanics on clinical outcomes in coronavirus disease 2019 (COVID-19) patients.</p><p><strong>Methods: </strong>Based on the patient's hospital admission, intubation time was defined as early (≤ 2 days) or late (> 2 days). Patients were further divided into three groups; early (≤ 3 days), late (4 - 6 days), and very late (> 6 days) intubated.</p><p><strong>Results: </strong>A total of 194 patients were included; 66.5% male, median age 65 years. Fifty-eight patients (29.9%) were intubated early and 136 (70.1%) late. Early intubated patients revealed lower mortality (44.8% vs. 72%, P < 0.001), were younger (60 vs. 67, P = 0.002), had lower sequential organ failure assessment (SOFA) scores (6 vs. 8, P = 0.002) and higher lung compliance on admission days 1, 6 and 12 (42 vs. 36, P = 0.006; 40 vs. 33, P < 0.001; and 37.5 vs. 32, P < 0.001, respectively). Older age (adjusted odds ratio (aOR) = 1.15, P < 0.001), intubation time (aOR = 1.15, P = 0.004), high SOFA scores (aOR = 1.81, P < 0.001), low partial pressure of oxygen (PaO₂)/fractional inspired oxygen tension (FiO₂) ratio (aOR = 0.96, P = 0.001), and low lung compliance on admission days 1 and 12 (aOR = 1.12, P = 0.012 and aOR = 1.14, P < 0.001, respectively) were associated with higher mortality. Very late and late intubated patients had higher mortality rates than patients intubated early (78.4% vs. 63.4% vs. 44.6%, respectively, P < 0.001).</p><p><strong>Conclusions: </strong>Among COVID-19 intubated patients, age, late intubation, high SOFA scores, low PaO₂/FiO₂ ratio, and low lung compliance are associated with higher intensive care unit (ICU) mortality.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 1","pages":"15-23"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10846488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139704397","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":"RAM Cannula Versus Bi-Nasal Prongs as Respiratory Device Interfaces in Neonates of Thirty-Two or More Weeks of Gestation With Respiratory Distress: The First \"ProRAM\" Randomized Trial Report.","authors":"Manar Al-Lawama, Bayan Alaraj, Mahmoud Abu Zahra, Ibtehal AlHasanat, Heba Habash, AbdelKareem Alhyari, Leen Alshajrawi, Sallam Jaafreh","doi":"10.14740/jocmr5077","DOIUrl":"10.14740/jocmr5077","url":null,"abstract":"<p><strong>Background: </strong>Using bilateral short nasal prongs as an interface for noninvasive respiratory support is challenging, and it is associated with nasal injury. We aimed to compare RAM cannula with nasal prongs in delivering noninvasive ventilation to newborn infants.</p><p><strong>Methods: </strong>This is a single-center randomized trial (trial registry: ISRCTN10561691). The setting involves a tertiary neonatal unit with a capacity of 30 beds and more than 13 years of experience in neonatal noninvasive ventilation. We included 50 infants born at ≥ 32 weeks of gestation, who had respiratory distress at birth. We excluded those with major congenital anomalies and those who required intubation in the delivery room. Primary outcomes were intubation rate and use of noninvasive positive-pressure ventilation (NIPPV); other outcomes included air leak and nasal injury rate. The infants were assigned using randomly generated numbers into bi-nasal prong and RAM canula groups in a 1:1 ratio.</p><p><strong>Results: </strong>Two and four babies in the RAM and prong groups, respectively, were upgraded to NIPPV (P = 0.600). One versus no baby in the RAM vs. prong groups was intubated (P = 1.000). Newborns in the prong group required oxygen support for a longer period (mean duration: 154.6 ± 255.2 h) than those in the RAM group (40.7 ± 72.6 h, P = 0.030). None of the patients in the RAM group had traumatic nasal injury compared to five babies in the prong group (P = 0.050). Four babies in our study developed air leaks, with two in each group.</p><p><strong>Conclusions: </strong>The use of RAM cannula in delivering noninvasive ventilation to newborns ≥ 32 weeks of age did not affect the noninvasive ventilation failure rate or incidence of air leak. The use was associated with a shorter duration of respiratory support and a reduced risk of nasal septal injury.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 1","pages":"24-30"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10846486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139704399","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":"Exploring Rational Management Methods for Medical Consumables","authors":"Shu Liu","doi":"10.32629/jcmr.v4i3.1309","DOIUrl":"https://doi.org/10.32629/jcmr.v4i3.1309","url":null,"abstract":"Purpose—The purpose of this article is to explore methods for the rational management of medical consumables, with the aim of providing reference for the future management of medical consumables. Methods—The hospital where the author is affiliated implemented a classification coding consumables management model in January 2021. Statistical analysis was conducted on the usage data of medical consumables for the full year of 2020 and 2021. The application effectiveness of the classification coding consumables management model in the workplace was evaluated. Results—In the third quarter and fourth quarter of 2021, the percentage of medical consumables usage per hundred yuan was 24.6% and 18.4%, respectively, both lower than 26.0% and 26.3% in 2020, with statistically significant differences (P<0.05). Compared to the year 2020, the total amount of medical consumables in 2021 increased by 21.2%, and the amount of high-value consumables increased by 40.4%, with an increase of 4.5% in the number of high-value consumable types. After comparing 300 cases of medical consumables sampled for each quarter, the rates of irrational usage in the second, third, and fourth quarters of 2021 were 14.0%, 12.7%, 11.7%, and 7.0%, respectively, all lower than 18.7% in 2020, with statistically significant differences (P<0.05). Conclusion—The management of medical consumables through classification coding can effectively control the percentage of medical consumables usage per hundred yuan, facilitate the control of various types of consumables, and increase the total revenue of medical consumables while reducing the rate of irrational usage.","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135322354","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":"Evaluation of the Use of Monopolar Low-Temperature Plasma Electrode in Lumbar Spinal Canal Expansion, Decompression, Bone Grafting, and Fusion Internal Fixation Surgery","authors":"Yuchao Liu, Xiucheng Li","doi":"10.32629/jcmr.v4i3.1307","DOIUrl":"https://doi.org/10.32629/jcmr.v4i3.1307","url":null,"abstract":"Objective: This study aims to explore the therapeutic effects of using a monopolar low-temperature plasma electrode and a high-frequency electrotome during lumbar spinal canal expansion, decompression, bone grafting, and fusion internal fixation surgery. The study also investigates the impact of these techniques on inflammatory indicators and quality of life in patients. Methods: A total of 100 patients with lumbar spondylolisthesis treated between June (January) 2022 and July (March) 2023 were selected for this study. They were randomly divided into a control group and an observation group, with 50 cases in each group. Both groups underwent lumbar spinal canal expansion, decompression, bone grafting, and fusion internal fixation surgery. The control group used a high-frequency electrotome during surgery, while the observation group used a monopolar low-temperature plasma electrode. Surgical indicators (operation time, intraoperative blood loss), inflammatory indicators, pain levels, and quality of life were compared between the two groups. Results: The operation time in the observation group was shorter than that in the control group (P<0.05). Postoperative levels of TNF-α and CRP were lower in the observation group than in the control group (P<0.05). The observation group had lower VAS scores and higher SF-36 scores compared to the control group (P<0.05). Conclusion: The use of a monopolar low-temperature plasma electrode in lumbar spinal canal expansion, decompression, bone grafting, and fusion internal fixation surgery yields positive therapeutic outcomes. It effectively reduces operation time, alleviates patient's inflammatory responses and pain levels, aids in postoperative recovery, and enhances quality of life. These results suggest the potential for wider adoption.","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135317206","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}