Diabetology International最新文献

{"title":"Calculated estimation of the metabolic clearance rate of insulin measured by glucose clamp examination in out-patient clinical practice.","authors":"Noboru Kurinami, Seigo Sugiyama, Akira Yoshida, Kunio Hieshima, Tomoko Suzuki, Fumio Miyamoto, Keizo Kajiwara, Katsunori Jinnouchi, Hideaki Jinnouchi","doi":"10.1007/s13340-024-00752-3","DOIUrl":"10.1007/s13340-024-00752-3","url":null,"abstract":"<p><strong>Purpose: </strong>A subpopulation of Japanese patients with type 2 diabetes mellitus (T2DM) who have elevated insulin clearance (IC) exists. We tested our hypothesis that it is possible to estimate IC using common and simple test results collected in routine clinical practice.</p><p><strong>Methods: </strong>We recruited patients with newly diagnosed, treatment-naïve T2DM and measured the metabolic clearance rate of insulin (MCRI) determined by a hyperinsulinemic-euglycemic clamp examination. Multivariable regression analysis was performed with body mass index (BMI), serum uric acid (UA), and fasting plasma insulin (F-IRI) which were independently associated with IC increase in our previous reports as explanatory variables to calculate a prediction equation for MCRI.</p><p><strong>Results: </strong>We enrolled 101 patients in this study. Because MCRI is not normally distributed, we calculated the logarithmically transformed estimated Log₁₀MCRI as a prediction formula for IC. Multivariable regression analysis showed that Log₁₀BMI (β =  - 0.3257, <i>P</i> < 0.001), UA (β =  - 0.1834, <i>P</i> = 0.0081), and Log₁₀F-IRI (β =  - 0.4367, <i>P</i> < 0.001) were significant independent factors for Log₁₀MCRI. The regression equation was as follows: estimated Log₁₀MCRI =  - 0.5421 × Log₁₀BMI - 0.0167 × UA - 0.1792 × Log₁₀F-IRI + 3.8251 (<i>r</i> = 0.7677, <i>R</i> ² = 0.5894, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>IC can easily be predicted using BMI, UA, and F-IRI which are common and simple test results collected in routine clinical practice.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"15 4","pages":"867-869"},"PeriodicalIF":1.3,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521266","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":"Hypovascular insulinoma with reduced microvessel density on histopathology: a case report.","authors":"Risako Imai, Mayu Sakai, Takehiro Kato, Sayako Ozeki, Sodai Kubota, Yanyan Liu, Yoshihiro Takahashi, Ken Takao, Masami Mizuno, Takuo Hirota, Yukio Horikawa, Takaaki Murakami, Tomohiro Kanayama, Takahiro Kuroda, Tatsuhiko Miyazaki, Daisuke Yabe","doi":"10.1007/s13340-024-00756-z","DOIUrl":"10.1007/s13340-024-00756-z","url":null,"abstract":"<p><p>Pancreatic neuroendocrine tumors (PanNETs) are generally hypervascular and readily detectable on imaging tests. However, hypovascular PanNETs are clinically problematic, requiring multiple imaging tests and tissue analyses to differentiate them from pancreatic ductal cancers. A 41 year-old man presented with Whipple's triad; 72 h fasting test followed by glucagon challenge test suggested insulinoma. However, contrast-enhanced computed tomography image showed a 17 mm tumor with poor enhancement and unclear borders in the tail of the pancreas<i>.</i> Abdominal magnetic resonance imaging and contrast-enhanced endoscopic ultrasonography (EUS) indicated cystic degeneration and necrosis at the same site; EUS-guided fine-needle aspiration cytology indicated a PanNET Grade 1 tumor. Although the imaging was inconclusive, diazoxide treatment ameliorated the hypoglycemia-related symptoms and insulinoma was deemed likely; following tail pancreatectomy and splenectomy, the symptoms disappeared. Pathological examination revealed a tumor positive for insulin and classed as PanNET Grade 1 according to the 2019 WHO classification. The microvessel density (MVD) of the tumor was found to be as low as 3.9%, which may partly account for the inconclusive images. The present case was difficult to diagnose preoperatively due to hypovascularity on imaging because of reduced MVD. It is clinically important to evaluate MVD in cases of hypovascular PanNETs by multiple preoperative imaging studies to differentiate them from pancreatic cancers and to validate the findings by postoperative pathological analysis.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"15 4","pages":"855-860"},"PeriodicalIF":1.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521289","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":"Type 1 diabetes: immune pathology and novel therapeutic approaches.","authors":"Eleanor M Ling, Joana R N Lemos, Khemraj Hirani, Matthias von Herrath","doi":"10.1007/s13340-024-00748-z","DOIUrl":"10.1007/s13340-024-00748-z","url":null,"abstract":"<p><p>Type 1 diabetes (T1D) is characterized by the progressive destruction of insulin-producing beta cells in the pancreas. Despite improvements in insulin monitoring techniques, there remains no cure for T1D. Individuals with T1D require lifelong insulin therapy and some develop life-threatening complications. T1D is a complex, multifactorial, autoimmune condition. Understanding why people get T1D and how it progresses has advanced our knowledge of the disease and led to the discovery of specific targets that can be therapeutically manipulated to halt or reverse the course of T1D. Scientists investigating the potential of immunotherapy treatment for the treatment have recently had some encouraging results. Teplizumab, an anti-CD3 monoclonal antibody that has been approved by the FDA, delays the onset of clinical T1D in patients ≥ 8 years of age with preclinical T1D and improves beta cell function. Therapies targeting beta cell health, vitality, and function are now thought to be an essential component of successful combination therapy for T1D. The idea that the beta cells themselves may influence their own destruction during the development of T1D is a notion that has recently been gaining acceptance in the field. Researchers have recently made remarkable strides in beta cell replacement therapy and beta cell regeneration techniques. This review offers a detailed exploration of the pathophysiological mechanisms of T1D. It discusses the intricate interplay of factors leading to T1D development and the innovative approaches being explored to discover new treatments and a cure for the millions of people living with T1D worldwide.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"15 4","pages":"761-776"},"PeriodicalIF":1.3,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521297","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":"Food-induced small bowel obstruction observed in a patient with inappropriate use of semaglutide.","authors":"Yoshito Itoh, Misato Tani, Ryo Takahashi, Koji Yamamoto","doi":"10.1007/s13340-024-00751-4","DOIUrl":"10.1007/s13340-024-00751-4","url":null,"abstract":"<p><p>We herein report a case of food-induced small bowel obstruction (FIBO) while using a glucagon-like peptide 1 receptor agonist (GLP1-RA), trying to lose weight due to distorted body image. The patient was a 30-year-old woman who was not obese (height 158 cm, weight 50 kg). She started taking an oral semaglutide, a GLP1-RA, and it was soon switched to weekly subcutaneous semaglutide because of ineffectiveness. More than 6 months after titrating up to 1.0 mg, she got drunk and chomped on a lot of scallops sandwiched between sheets of kelp, so-called \"kobujime\" in Japan, and half a day later complained of abdominal pain. Based on a finding of computed tomography at our emergency department, she was suspected of having a bowel obstruction and underwent laparoscopic surgery, which resulted in a diagnosis of small bowel obstruction by kelp. FIBO is rare, but it can become very severe once it happens. Although we cannot prove the direct pathophysiological effects of GLP1-RAs on FIBO in this particular case, GLP1-RAs have been reported to be one of the underlying risks of bowel obstruction based on epidemiological and basic research evidence; still, it is under-recognized. For example, the package inserts in Japan do not mention intestinal obstruction. We hope that the present report will prove helpful in paying attention to GLP1-RAs as a factor in bowel obstruction, including FIBO.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"15 4","pages":"850-854"},"PeriodicalIF":1.3,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521273","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":"Genetics of type-1 diabetes.","authors":"Hiroshi Ikegami, Shinsuke Noso","doi":"10.1007/s13340-024-00754-1","DOIUrl":"10.1007/s13340-024-00754-1","url":null,"abstract":"<p><p>Type-1 diabetes is a multifactorial disease characterized by genetic and environmental factors that contribute to its development and progression. Despite progress in the management of type-1 diabetes, the final goal of curing the disease is yet to be achieved. To establish effective methods for the prevention, intervention, and cure of the disease, the molecular mechanisms and pathways involved in its development and progression should be clarified. One effective approach is to identify genes responsible for disease susceptibility and apply information obtained from the function of genes in disease etiology for the protection, intervention, and cure of type-1 diabetes. In this review, we discuss the genetic basis of type-1 diabetes, along with prospects for its prevention, intervention, and cure for type-1 diabetes.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"15 4","pages":"688-698"},"PeriodicalIF":1.3,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521275","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":"Diurnal variation in the association between the scan frequency of isCGM and CGM metrics: post hoc analysis of the ISCHIA study.","authors":"Shu Meguro, Naoki Sakane, Kiminori Hosoda, Yushi Hirota, Arata Itoh, Ken Kato, Noriko Kodani, Akio Kuroda, Munehide Matsuhisa, Junnosuke Miura, Akira Shimada, Atsuhito Tone, Masao Toyoda, Takashi Murata","doi":"10.1007/s13340-024-00749-y","DOIUrl":"10.1007/s13340-024-00749-y","url":null,"abstract":"<p><strong>Background and aims: </strong>To investigate the association between the frequency of intermittent-scanning continuous glucose monitoring (isCGM) and diurnal variation of time in range (TIR), time above range (TAR), and time below range (TBR), we performed a post hoc analysis of the ISCHIA study, a multicenter, prospective, open-label, randomized crossover study of patients with type 1 diabetes mellitus.</p><p><strong>Method: </strong>Data of 93 people who completed the ISCHIA study were used. We calculated scan frequency, TAR, TIR, and TBR of four approximately 6-h intervals: 6:00-11:59 (morning), 12:00-17:59 (afternoon), 18:00-23:59 (evening), and 0:00-5:59 (night). The correlation between scan frequency and diurnal variation of CGM metrics was analyzed using nonparametric Spearman correlation analysis.</p><p><strong>Results: </strong>More frequent scanning was associated with higher TIR in the afternoon (rho = 0.343, P < 0.001), evening (rho = 0.243, P = 0.019), and night (rho = 0.218, P = 0.036); furthermore, it was associated with lower TAR in the afternoon (rho = -0.275, P = 0.008) and TBR in the evening (rho = -0.235, P = 0.024). Concern about the effect of blood glucose fluctuation on social communication affected the number of scans during the day. Concerns about loneliness and hypoglycemia when alone also influenced the number of nighttime scans.</p><p><strong>Conclusion: </strong>Scan frequency is influenced by psychological factors. Afternoon scans were associated with the highest increase in TIR and decrease in TAR. Evening scans were linked to a reduction in TBR.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"15 4","pages":"828-836"},"PeriodicalIF":1.3,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521269","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":"Questionnaire survey on severe hypoglycemia in pediatric patients with diabetes-English version.","authors":"Tatsuhiko Urakami, Tomoyuki Hotsubo, Yohei Ogawa, Toru Kikuchi, Rika Usuda, Katsuyuki Matsui, Masakazu Hirose, Hiroki Hirai, Norio Abiru, Ikuma Fujiwara, Haruo Mizuno, Kenichi Miyako, Kazuma Takahashi, Akira Shimada","doi":"10.1007/s13340-024-00742-5","DOIUrl":"10.1007/s13340-024-00742-5","url":null,"abstract":"<p><p>A questionnaire survey on severe hypoglycemia (SH) in pediatric patients with diabetes was distributed to pediatric diabetes specialists and members of the Committee of Pediatric Diabetes in the Japan Diabetes Society. Thirty-three hospitals answered the questionnaire survey, and 17 had treated the eligible patients under 15 years of age, including 506 with type 1 diabetes and 302 with type 2 diabetes. Of these patients, 25 experienced SH from January 2017 to December 2021. SH occurred in 3 patients at 0-5 years, 5 at 5-10 years, and 15 at 10-15 years, and it most frequently occurred between the times of 0:00 and 08:00 a.m. The majority of the patients had SH at home during the nighttime. Only 4 patients experienced SH during school time. Eleven patients took glucose orally, while 5 used glucagon nasal powder. Fifteen patients were transferred to hospital emergency units for the management of SH. From these results, the frequency of SH was estimated to be 0.01/patient/year, and the treatment for SH seemed insufficient.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"15 4","pages":"666-672"},"PeriodicalIF":1.3,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521294","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 comorbidity burden of type 2 diabetes mellitus (T2DM): sex differences and associated factors among 830 cases in North-Eastern Morocco.","authors":"Ikram Kenfaoui, Said Bouchefra, Siham Daouchi, Abderrahim Benzakour, Mohammed Ouhssine","doi":"10.1007/s13340-024-00750-5","DOIUrl":"10.1007/s13340-024-00750-5","url":null,"abstract":"<p><strong>Background and aim: </strong>Type 2 diabetes is prone to numerous comorbidities resulting from complex mechanisms involving hyperglycemia, insulin resistance, low-grade inflammation and accelerated atherogenesis. The purpose of the present study was to investigate these disorders and their associated risk factors according to patient sex in a population of type 2 diabetics in North-Eastern Morocco.</p><p><strong>Methods: </strong>This study was conducted in a medical analysis laboratory over a 1-year period from 01/10/2018 to 01/10/2019. This epidemiological study was carried out on 830 subjects aged 18 and over. Quantitative variables were expressed as means ± standard deviation, and qualitative variables as frequencies and percentages. Hypothesis tests used to compare means and proportions were Student's <i>t</i>-test and Chi-square test of independence, respectively. Logistic regression was used to predict risk factors for each diabetes.</p><p><strong>Results: </strong>830 patients were surveyed. 95.66% had diabetes-related comorbidities. Hypertension (23.7%), nephropathy (18.19%), dyslipidemia (14.82%), thyroid dysfunction (10.72%), cataract (10.12%), diabetic foot (7.23%), ketoacidosis (6.27%), retinopathy (3.49%), and skin disorders (2.77%) were observed. Sex was associated with dyslipidemia (<i>p</i> = 0.025), hypertension (<i>p</i> = 0.032) and retinopathy (<i>p</i> = 0.029). Uncontrolled blood sugar, unbalanced lipid profile, age, physical activity, obesity, smoking, and alcohol consumption were risk factors with differential involvement in the occurrence of the mentioned pathologies.</p><p><strong>Conclusions: </strong>The results of our study showed that a significant proportion of the population suffers from diabetic comorbidities. To meet this challenge, further research is needed to identify the mechanisms of action of these factors, to control them and combat diabetogenic environments by setting up adapted educational programs.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"15 4","pages":"814-827"},"PeriodicalIF":1.3,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11513066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521295","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":"Impact of hyperglycemia on immune cell function: a comprehensive review.","authors":"Hoyul Lee, Min-Ji Kim, In-Kyu Lee, Chang-Won Hong, Jae-Han Jeon","doi":"10.1007/s13340-024-00741-6","DOIUrl":"10.1007/s13340-024-00741-6","url":null,"abstract":"<p><p>Hyperglycemia, a hallmark of diabetes and various metabolic disorders, has profound implications for immune cell function. The relationship between elevated blood glucose levels and immune cell function is a topic of significant medical interest. In this review, we aim to comprehensively review effects of hyperglycemia on various immune cell types and its clinical implications, particularly T cells, macrophages, natural killer cells, and neutrophils. It aims to consolidate current knowledge on the subject, with a focus on both type 1 and type 2 diabetes, as well as other pathological states where hyperglycemia is a concern. A comprehensive examination of recent studies and clinical data was conducted to assess effects of hyperglycemia on immune cell function. Evidence indicates that hyperglycemia can significantly alter immune cell function, with different diabetic conditions showing varied responses. Roles of key metabolic hormones in regulating T cell function highlight potential therapeutic targets for restoring immune balance. In addition, reprogramming of innate immune cells such as macrophages and natural killer cells under hyperglycemic conditions suggests a complex metabolic-immunological interface. This review will contribute to a better understanding of the link between diabetes, other metabolic disorders, and immune function. By examining recent research and clinical findings, this review will enhance our comprehension of the mechanisms at play and guide future medical strategies for managing and treating conditions associated with hyperglycemia.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"15 4","pages":"745-760"},"PeriodicalIF":1.3,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521290","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":"'DKD' as the kidney disease relevant to individuals with diabetes.","authors":"Keizo Kanasaki, Masaomi Nangaku, Kohjiro Ueki","doi":"10.1007/s13340-024-00747-0","DOIUrl":"10.1007/s13340-024-00747-0","url":null,"abstract":"<p><p>Even though chronic kidney disease (CKD) is a significant comorbidity in individuals with diabetes, there appears to be worldwide confusion regarding the terminology used to describe it, including diabetic nephropathy, diabetic kidney disease (DKD), CKD with diabetes, diabetes and CKD, etc. In Japan, we have encountered similar confusion regarding the terminology used to describe kidney disease in individuals with diabetes, especially when written in Japanese due to terminological similarities in Chinese characters. The primary issue in Japan was deciphering the significance of \"Diabetic,\" specifically whether it is an essential attribute of the condition itself. The confusions may arise from the deficiencies in establishing a clear criterion for the disease concept, whether it is diabetic nephropathy or DKD. Furthermore, among specialists in the field, each may have their own concept of the disease. In this regard, the Japanese Diabetes Society and the Japanese Society of Nephrology updated the corresponding Japanese term for DKD and defined the concept of DKD with rationale. The goal of these efforts should be the future improvement of the prognosis of DKD patients, the stakeholders.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"15 4","pages":"673-676"},"PeriodicalIF":1.3,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521270","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}