Abstract Background: Femoral interlocking intramedullary (IM) nailing fixation is an effective method for the treatment of femoral shaft fractures. Aseptic nonunion of femoral shaft fracture after IM nailing is uncommon. Currently, the treatment for aseptic femoral shaft nonunion is controversial. The aim of this study was to investigate the clinical effect of augmentative antirotational plating plus decortication and autogenic bone grafting for aseptic femoral shaft nonunion after IM nailing failure. Methods: A retrospective study was conducted on 25 cases of aseptic femoral shaft fracture nonunion treated with IM nailing from January 2015 to August 2019. All patients were treated by leaving the nail in situ, debridement of nonunion sites, decortication, autogenous iliac bone grafting, and augmentative antirotational plating fixation. The time to fracture union and complications were recorded. Results: All patients were followed up for 12–18 months. The union rate after revision surgery was 100%. The average union time was 5.5 months (range, 4-10). Subjective pain symptoms had disappeared in all patients. There were no incision infections or internal fixator fatigue fractures. Average scores of the physical function and bodily pain components of the SF-36 were 95.5 (range, 91-98) and 94.1 (range, 90-97), respectively. No other obvious complications occurred postoperatively. Conclusion: Augmentative antirotational plating plus decortication and autogenic bone grafting is an excellent choice for treating femoral shaft fracture nonunion after IM nailing; this approach has an overall high union rate and few complications.
{"title":"The efficacy of augmentative anti-rotational plating plus decortication and autogenic bone grafting for aseptic nonunion after intramedullary nailing of femoral shaft fracture","authors":"Yonggang Li, Hanbing Xing, X. Qi, Mingxing Liu, Zhiyong Wang, Xiguang Sang","doi":"10.1097/EC9.0000000000000022","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000022","url":null,"abstract":"Abstract Background: Femoral interlocking intramedullary (IM) nailing fixation is an effective method for the treatment of femoral shaft fractures. Aseptic nonunion of femoral shaft fracture after IM nailing is uncommon. Currently, the treatment for aseptic femoral shaft nonunion is controversial. The aim of this study was to investigate the clinical effect of augmentative antirotational plating plus decortication and autogenic bone grafting for aseptic femoral shaft nonunion after IM nailing failure. Methods: A retrospective study was conducted on 25 cases of aseptic femoral shaft fracture nonunion treated with IM nailing from January 2015 to August 2019. All patients were treated by leaving the nail in situ, debridement of nonunion sites, decortication, autogenous iliac bone grafting, and augmentative antirotational plating fixation. The time to fracture union and complications were recorded. Results: All patients were followed up for 12–18 months. The union rate after revision surgery was 100%. The average union time was 5.5 months (range, 4-10). Subjective pain symptoms had disappeared in all patients. There were no incision infections or internal fixator fatigue fractures. Average scores of the physical function and bodily pain components of the SF-36 were 95.5 (range, 91-98) and 94.1 (range, 90-97), respectively. No other obvious complications occurred postoperatively. Conclusion: Augmentative antirotational plating plus decortication and autogenic bone grafting is an excellent choice for treating femoral shaft fracture nonunion after IM nailing; this approach has an overall high union rate and few complications.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"2 1","pages":"61 - 66"},"PeriodicalIF":0.0,"publicationDate":"2021-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45256983","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}
Pub Date : 2021-12-07DOI: 10.1097/EC9.0000000000000014
Jie Wang, F. Yan
Abstract Ribosomes are important organelles for synthesizing proteins in cells. They are composed of ribosomal RNA and more than 80 ribosomal proteins. It is well known that an essential function of ribosomal proteins is to participate in protein translation. In addition, ribosomal proteins also perform extra-ribosomal functions, such as participating in DNA replication, transcription, and damage repair, regulating cell growth, proliferation, apoptosis, and transformation. In recent years, studies have shown that alterations in ribosomal protein synthesis or function can lead to various hematologic diseases, including Diamond-Blackfan anemia, 5q-syndrome, Shwachman-Diamond syndrome, and other blood system diseases. Moreover, abnormal expressions of specific ribosomal protein genes have been reported in many malignant tumors. In this review, we elaborated on the changes in ribosomal proteins in hepatocellular carcinoma and colorectal, prostate, gastric, esophageal, and other cancers and discussed the relationship between ribosomal proteins and the occurrence of hematologic disorders and cancers.
{"title":"Roles of ribosomal proteins in hematologic disorders and cancers: a review","authors":"Jie Wang, F. Yan","doi":"10.1097/EC9.0000000000000014","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000014","url":null,"abstract":"Abstract Ribosomes are important organelles for synthesizing proteins in cells. They are composed of ribosomal RNA and more than 80 ribosomal proteins. It is well known that an essential function of ribosomal proteins is to participate in protein translation. In addition, ribosomal proteins also perform extra-ribosomal functions, such as participating in DNA replication, transcription, and damage repair, regulating cell growth, proliferation, apoptosis, and transformation. In recent years, studies have shown that alterations in ribosomal protein synthesis or function can lead to various hematologic diseases, including Diamond-Blackfan anemia, 5q-syndrome, Shwachman-Diamond syndrome, and other blood system diseases. Moreover, abnormal expressions of specific ribosomal protein genes have been reported in many malignant tumors. In this review, we elaborated on the changes in ribosomal proteins in hepatocellular carcinoma and colorectal, prostate, gastric, esophageal, and other cancers and discussed the relationship between ribosomal proteins and the occurrence of hematologic disorders and cancers.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"3 1","pages":"23 - 31"},"PeriodicalIF":0.0,"publicationDate":"2021-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48295471","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}
Pub Date : 2021-12-01DOI: 10.1097/EC9.0000000000000002
Xian-Yu Shi, Yang Wu, Haibin Li, S. Ma, Dou Li, Ding Gao, H. Cui, Changxiao Yu, Song Yang, Ziren Tang, Fei Shao
Abstract Aim: We aimed to investigate the association between bystander cardiopulmonary resuscitation (CPR) and survival of patients with out-of-hospital cardiac arrests (OHCA) in Beijing. Methods: This observational study analyzed adult patients with OHCA treated by the Beijing emergency medical service (EMS) from January 2013 to December 2017. Data were collected in a Utstein style with a 1-year follow-up and a primary outcome of survival to hospital discharge. Secondary outcomes were return of spontaneous circulation (ROSC), survival to admission, favorable neurological outcome at hospital discharge, and survival and favorable neurological outcomes of up to 1 year. Results: A total of 5016 patients with OHCA from Beijing's urban area were recorded by EMS, wherein 765 patients (15.25%) underwent bystander CPR. The data were propensity score-matched forage, sex, location, witness, aetiology, initial rhythm, and call to EMS arrival to compare the difference between the occurrence and nonoccurrence of bystander CPR. The survival upon the discharge of patients who experienced bystander CPR was superior to that of patients who did not receive bystander CPR (3.7% vs 1.2%, respectively; P < 0.001). Moreover, patients with OHCA resuscitated with bystander CPR achieved better outcomes of ROSC, survival to admission, favorable neurological outcome at hospital discharge, survival and favorable neurological outcome after 1 year compared with those who were not resuscitated with bystander CPR. Conclusion: Survival and neurological outcome of patients who underwent bystander CPR was better than those who underwent nonbystander CPR in Beijing. However, the rate of bystander CPR was low.
{"title":"Outcome of bystander cardiopulmonary resuscitation after out-of-hospital cardiac arrest in Beijing","authors":"Xian-Yu Shi, Yang Wu, Haibin Li, S. Ma, Dou Li, Ding Gao, H. Cui, Changxiao Yu, Song Yang, Ziren Tang, Fei Shao","doi":"10.1097/EC9.0000000000000002","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000002","url":null,"abstract":"Abstract Aim: We aimed to investigate the association between bystander cardiopulmonary resuscitation (CPR) and survival of patients with out-of-hospital cardiac arrests (OHCA) in Beijing. Methods: This observational study analyzed adult patients with OHCA treated by the Beijing emergency medical service (EMS) from January 2013 to December 2017. Data were collected in a Utstein style with a 1-year follow-up and a primary outcome of survival to hospital discharge. Secondary outcomes were return of spontaneous circulation (ROSC), survival to admission, favorable neurological outcome at hospital discharge, and survival and favorable neurological outcomes of up to 1 year. Results: A total of 5016 patients with OHCA from Beijing's urban area were recorded by EMS, wherein 765 patients (15.25%) underwent bystander CPR. The data were propensity score-matched forage, sex, location, witness, aetiology, initial rhythm, and call to EMS arrival to compare the difference between the occurrence and nonoccurrence of bystander CPR. The survival upon the discharge of patients who experienced bystander CPR was superior to that of patients who did not receive bystander CPR (3.7% vs 1.2%, respectively; P < 0.001). Moreover, patients with OHCA resuscitated with bystander CPR achieved better outcomes of ROSC, survival to admission, favorable neurological outcome at hospital discharge, survival and favorable neurological outcome after 1 year compared with those who were not resuscitated with bystander CPR. Conclusion: Survival and neurological outcome of patients who underwent bystander CPR was better than those who underwent nonbystander CPR in Beijing. However, the rate of bystander CPR was low.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"1 1","pages":"64 - 69"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48501022","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}
Pub Date : 2021-11-22DOI: 10.1097/EC9.0000000000000012
Jiali Wang, F. Xu, J. Pang, W. Zheng, Yuguo Chen
Abstract Jiali Wang and colleagues discuss challenges owing to the assessment and management of patients presenting to emergency department with acute chest pain in China and effective strategies to lessen the pressure on health care systems and improve quality of care.
{"title":"Emergency care for chest pain in China: the unmet challenges","authors":"Jiali Wang, F. Xu, J. Pang, W. Zheng, Yuguo Chen","doi":"10.1097/EC9.0000000000000012","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000012","url":null,"abstract":"Abstract Jiali Wang and colleagues discuss challenges owing to the assessment and management of patients presenting to emergency department with acute chest pain in China and effective strategies to lessen the pressure on health care systems and improve quality of care.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"1 1","pages":"82 - 85"},"PeriodicalIF":0.0,"publicationDate":"2021-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49627664","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}
Pub Date : 2021-11-17DOI: 10.1097/ec9.0000000000000019
Yuguo Chen
{"title":"Expert consensus on the emergency diagnosis and therapy of acute chest pain (English version)","authors":"Yuguo Chen","doi":"10.1097/ec9.0000000000000019","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000019","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49191745","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}
Pub Date : 2021-11-17DOI: 10.1097/EC9.0000000000000015
Yoshiro Kobe, Y. Tateishi, S. Oda
Abstract Background: Recent decreases in the incidence of postoperative liver failure (POLF) have been attributed to advances in surgical techniques, critical care, and postoperative management. However, POLF management remains a challenge, and worsening POLF is a significant cause of morbidity and mortality. Therapeutic plasma exchange (TPE) is used as a salvage strategy for POLF in some countries, and several studies conducted between 1980 and 1990 have reported the use of TPE for POLF. We conducted this retrospective single-center study to investigate the outcomes of patients with POLF treated with TPE. Methods: We retrospectively reviewed the charts of patients with POLF admitted to the intensive care unit who underwent TPE between November 2010 and March 2017. POLF was defined as the presence of persistent hyperbilirubinemia. Data on patient demographics, Glasgow Coma Scale score, platelet count, prothrombin time, and serum total bilirubin level were collected, and their Sequential Organ Failure Assessment scores were calculated. The lengths of postoperative hospital stays, lengths of post-TPE hospital stays, and patient outcomes were also analyzed. Results: TPE was performed in 20 patients with POLF during the study period. TPE was initiated on the 49th postoperative day and was performed for a median of five sessions. TPE improved hyperbilirubinemia and coagulopathy but had no effect on neurological and clinical symptoms. All 20 patients treated with TPE died after the 36th day (median) from the initial TPE. Conclusions: Although TPE may improve laboratory values in patients with POLF, the current study suggests that it has no survival benefit.
{"title":"Effects of therapeutic plasma exchange on survival in patients with postoperative liver failure: a retrospective single-center study","authors":"Yoshiro Kobe, Y. Tateishi, S. Oda","doi":"10.1097/EC9.0000000000000015","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000015","url":null,"abstract":"Abstract Background: Recent decreases in the incidence of postoperative liver failure (POLF) have been attributed to advances in surgical techniques, critical care, and postoperative management. However, POLF management remains a challenge, and worsening POLF is a significant cause of morbidity and mortality. Therapeutic plasma exchange (TPE) is used as a salvage strategy for POLF in some countries, and several studies conducted between 1980 and 1990 have reported the use of TPE for POLF. We conducted this retrospective single-center study to investigate the outcomes of patients with POLF treated with TPE. Methods: We retrospectively reviewed the charts of patients with POLF admitted to the intensive care unit who underwent TPE between November 2010 and March 2017. POLF was defined as the presence of persistent hyperbilirubinemia. Data on patient demographics, Glasgow Coma Scale score, platelet count, prothrombin time, and serum total bilirubin level were collected, and their Sequential Organ Failure Assessment scores were calculated. The lengths of postoperative hospital stays, lengths of post-TPE hospital stays, and patient outcomes were also analyzed. Results: TPE was performed in 20 patients with POLF during the study period. TPE was initiated on the 49th postoperative day and was performed for a median of five sessions. TPE improved hyperbilirubinemia and coagulopathy but had no effect on neurological and clinical symptoms. All 20 patients treated with TPE died after the 36th day (median) from the initial TPE. Conclusions: Although TPE may improve laboratory values in patients with POLF, the current study suggests that it has no survival benefit.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"1 1","pages":"70 - 74"},"PeriodicalIF":0.0,"publicationDate":"2021-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49447663","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}
Pub Date : 2021-11-17DOI: 10.1097/EC9.0000000000000020
Baotao Huang
Abstract Extracorporeal membrane oxygenation (ECMO) is a last resort life support in several patients with cardiogenic shock. However, appropriate candidates and optimal timing of ECMO initiation need to be established. The present report reviewed relevant literatures to refine the allocation of ECMO in patients with cardiogenic shock. The PubMed database was searched from inception to October 5, 2020, using the following search terms: “extracorporeal membrane oxygenation” or “mechanical circulatory support” AND “cardiogenic shock” or “cardiac arrest” or “myocardial infarction” or “fulminant myocarditis.” The etiology of cardiogenic shock, widened QRS duration, QTc interval prolongation, cardiac arrest, dynamic narrowing of pulse pressure, and speed of lactate accumulation per unit time can be associated with the course of cardiogenic shock, and typically warn that advanced medical circulatory support is required. In the critical moment when the circulatory status deteriorates sharply, an immediate physical examination combined with ready-to-use tools such as monitoring data or blood gas analysis results is crucial for assessing the appropriateness and timing of ECMO initiation.
{"title":"Candidates and allocation time for extracorporeal membrane oxygenation in patients with cardiogenic shock","authors":"Baotao Huang","doi":"10.1097/EC9.0000000000000020","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000020","url":null,"abstract":"Abstract Extracorporeal membrane oxygenation (ECMO) is a last resort life support in several patients with cardiogenic shock. However, appropriate candidates and optimal timing of ECMO initiation need to be established. The present report reviewed relevant literatures to refine the allocation of ECMO in patients with cardiogenic shock. The PubMed database was searched from inception to October 5, 2020, using the following search terms: “extracorporeal membrane oxygenation” or “mechanical circulatory support” AND “cardiogenic shock” or “cardiac arrest” or “myocardial infarction” or “fulminant myocarditis.” The etiology of cardiogenic shock, widened QRS duration, QTc interval prolongation, cardiac arrest, dynamic narrowing of pulse pressure, and speed of lactate accumulation per unit time can be associated with the course of cardiogenic shock, and typically warn that advanced medical circulatory support is required. In the critical moment when the circulatory status deteriorates sharply, an immediate physical examination combined with ready-to-use tools such as monitoring data or blood gas analysis results is crucial for assessing the appropriateness and timing of ECMO initiation.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"1 1","pages":"75 - 81"},"PeriodicalIF":0.0,"publicationDate":"2021-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41797663","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}
Supplemental Digital Content is available in the text Abstract Background: Cardiomyopathy has a variety of etiologies. Here, we report a case of iron overload cardiomyopathy (IOC) in combination with hereditary stomatocytosis (HST) due to a rare mutation in the PIEZO1 gene. Case summary: A 31-year-old man presented to the clinic with a new onset of fatigue and abdominal distension. He had a history of 9-year cholelithiasis, 4-year hemolytic anemia, 7-month diabetes mellitus (DM), and 6-month low sex drive. The specific features of bronze skin, liver palms, yellow eyes, DM, and cardiomyopathy raised our suspicion of hemochromatosis, which was confirmed by an elevated serum ferritin concentration and high transferrin saturation. Echocardiography and cardiovascular magnetic resonance (CMR) imaging demonstrated dilation of all cardiac cavities with a left ventricular ejection fraction of 30%. CMR T2∗ mapping showed myocardial, hepatic, and pancreatic siderosis. Next-generation sequencing identified one missense variant in the PIEZO1 gene (c.2005G>T), which conferred HST and hyperferritinemia. We screened his close family members and identified his son as a heterozygous carrier of this variant, who had intermittent jaundice. Conclusion: In this case, the PIEZO1 c.2005G>T mutation conferred HST and IOC, complicated with cholelithiasis, DM, and low sex drive. Bronze skin, liver cirrhosis, cardiomyopathy, and DM are red flags, while magnetic resonance imaging T2∗ mapping, blood iron metabolism markers, and gene testing are valuable in the diagnosis.
{"title":"The PIEZO1 gene mutation (c.2005G>T) causes iron overload cardiomyopathy: a case report","authors":"Sumei Cui, Huixia Lu, Shujian Wei, Chuanbao Li, F. Xu, Yuguo Chen","doi":"10.1097/EC9.0000000000000018","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000018","url":null,"abstract":"Supplemental Digital Content is available in the text Abstract Background: Cardiomyopathy has a variety of etiologies. Here, we report a case of iron overload cardiomyopathy (IOC) in combination with hereditary stomatocytosis (HST) due to a rare mutation in the PIEZO1 gene. Case summary: A 31-year-old man presented to the clinic with a new onset of fatigue and abdominal distension. He had a history of 9-year cholelithiasis, 4-year hemolytic anemia, 7-month diabetes mellitus (DM), and 6-month low sex drive. The specific features of bronze skin, liver palms, yellow eyes, DM, and cardiomyopathy raised our suspicion of hemochromatosis, which was confirmed by an elevated serum ferritin concentration and high transferrin saturation. Echocardiography and cardiovascular magnetic resonance (CMR) imaging demonstrated dilation of all cardiac cavities with a left ventricular ejection fraction of 30%. CMR T2∗ mapping showed myocardial, hepatic, and pancreatic siderosis. Next-generation sequencing identified one missense variant in the PIEZO1 gene (c.2005G>T), which conferred HST and hyperferritinemia. We screened his close family members and identified his son as a heterozygous carrier of this variant, who had intermittent jaundice. Conclusion: In this case, the PIEZO1 c.2005G>T mutation conferred HST and IOC, complicated with cholelithiasis, DM, and low sex drive. Bronze skin, liver cirrhosis, cardiomyopathy, and DM are red flags, while magnetic resonance imaging T2∗ mapping, blood iron metabolism markers, and gene testing are valuable in the diagnosis.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"1 1","pages":"86 - 89"},"PeriodicalIF":0.0,"publicationDate":"2021-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61678418","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}
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