Inflammatory Intestinal Diseases最新文献

{"title":"Front & Back Matter","authors":"","doi":"10.1159/000521404","DOIUrl":"https://doi.org/10.1159/000521404","url":null,"abstract":"","PeriodicalId":13605,"journal":{"name":"Inflammatory Intestinal Diseases","volume":"68 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80337920","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":"Contents Vol. 6, 2021","authors":"G. Rogler, T. Hibi, S. Danese, M. Scharl, S. Shinzaki, B. Ye","doi":"10.1159/000521119","DOIUrl":"https://doi.org/10.1159/000521119","url":null,"abstract":"Silvio Danese – Humanitas University, Rozzano (MI), Italy Hans Herfarth – University of North Carolina, Chapel Hill, NC, USA Beat Müllhaupt – University Hospital, Zurich, Switzerland Choon Jin Ooi – Gleneagles Medical Centre, Singapore, Singapore Masakazu Nagahori – Tokyo Medical and Dental University, Medical Hospital, Tokyo, Japan Zhihua Ran – Shanghai Jiao Tong University, Shanghai, China Florian Rieder – Lerner Research Institute, Cleveland, OH, USA Ala Sharara – American University of Beirut Medical Center, Beirut, Lebanon Stephan Vavricka – Zentrum für Gastroenterologie und Hepatologie, Zurich, Switzerland Kenji Watanabe – Hyogo College of Medicine, Nishinomiya, Japan Mamoru Watanabe – Tokyo Medical and Dental University, Tokyo, Japan Gillian Watermeyer – Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa Ming-Shiang Wu – National Taiwan University, Taipei, Taiwan Suk-Kyun Yang – University of Ulsan College of Medicine, Seoul, Korea","PeriodicalId":13605,"journal":{"name":"Inflammatory Intestinal Diseases","volume":"12 1","pages":"I - IV"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80831988","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":"Acknowledgement to Reviewers","authors":"","doi":"10.1159/000520707","DOIUrl":"https://doi.org/10.1159/000520707","url":null,"abstract":"© 2021 S. Karger AG, Basel Karger Publishers and the editors of Inflammatory Intestinal Diseases would like to thank the reviewers for their support in reviewing manuscripts for the journal. We sincerely thank all contributing reviewers who have volunteered their time, effort, and expertise to improve the quality of the manuscripts in 2021. Individual reviewers can also claim their personal ‘Certificate of Review’ via the journal’s manuscript submission system.","PeriodicalId":13605,"journal":{"name":"Inflammatory Intestinal Diseases","volume":"73 1","pages":"225 - 225"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86038950","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":"Impact of Diagnostic Delay on Disease Course in Pediatric- versus Adult-Onset Patients with Ulcerative Colitis: Data from the Swiss IBD Cohort.","authors":"Alain M Schoepfer,&nbsp;Vu Dang Chau Tran,&nbsp;Jean-Benoit Rossel,&nbsp;Christiane Sokollik,&nbsp;Johannes Spalinger,&nbsp;Ekaterina Safroneeva,&nbsp;Thea von Graffenried,&nbsp;Sébastien Godat,&nbsp;Dieter Hahnloser,&nbsp;Stephan R Vavricka,&nbsp;Christian Braegger,&nbsp;Andreas Nydegger","doi":"10.1159/000520995","DOIUrl":"https://doi.org/10.1159/000520995","url":null,"abstract":"<p><strong>Introduction: </strong>Given the lack of data, we aimed to assess the impact of the length of diagnostic delay on the natural history of ulcerative colitis (UC) in pediatric (diagnosed <18 years) and adult patients (diagnosed ≥18 years).</p><p><strong>Methods: </strong>Data from the Swiss Inflammatory Bowel Disease Cohort Study were analyzed. Diagnostic delay was defined as the interval between the first appearance of UC-related symptoms until diagnosis. Logistic regression modeling evaluated the appearance of the following complications in the long term according to the length of diagnostic delay: colonic dysplasia, colorectal cancer, UC-related hospitalization, colectomy, and extraintestinal manifestations (EIMs).</p><p><strong>Results: </strong>A total of 184 pediatric and 846 adult patients were included. The median diagnostic delay was 4 [IQR 2-7.5] months for the pediatric-onset group and 3 [IQR 2-10] months for the adult-onset group (<i>p</i> = 0.873). In both, pediatric- and adult-onset groups, the length of diagnostic delay at UC diagnosis was not associated with colectomy, UC-related hospitalization, colon dysplasia, and colorectal cancer. EIMs were significantly more prevalent at UC diagnosis in the adult-onset group with long diagnostic delay than in the adult-onset group with short diagnostic delay (<i>p</i> = 0.022). In the long term, the length of diagnostic delay was associated in the adult-onset group with colorectal dysplasia (<i>p</i> = 0.023), EIMs (<i>p</i> < 0.001), and more specifically arthritis/arthralgias (<i>p</i> < 0.001) and ankylosing spondylitis/sacroiliitis (<i>p</i> < 0.001). In the pediatric-onset UC group, the length of diagnostic delay in the long term was associated with arthritis/arthralgias (<i>p</i> = 0.017); however, it was not predictive for colectomy and UC-related hospitalization.</p><p><strong>Conclusions: </strong>As colorectal cancer and EIMs are associated with considerable morbidity and costs, every effort should be made to reduce diagnostic delay in UC patients.</p>","PeriodicalId":13605,"journal":{"name":"Inflammatory Intestinal Diseases","volume":"7 2","pages":"87-96"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9294935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40706570","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":"Stopping Anti-TNF in Crohn’s Disease Remitters: Pros and Cons: The Pros","authors":"E. Louis","doi":"10.1159/000520942","DOIUrl":"https://doi.org/10.1159/000520942","url":null,"abstract":"Background: There is no cure for Crohn’s disease (CD). Available treatments and treatment strategies, particularly anti-TNF, allow healing intestinal lesions and maintaining steroid-free remission in a subset of patients. Having in mind the remitting/relapsing nature of the disease, patients and health care providers often ask themselves whether the treatment could be withdrawn. Several studies have demonstrated a risk of relapse of CD after anti-TNF withdrawal, which varies from 20 to 50% at 1 year and from 50 to 80% beyond 5 years. These numbers clearly highlight that stopping therapy should not be a systematically proposed strategy in those remitting patients. Summary: Nobody would argue for anti-TNF withdrawal in patients with a high risk of short-term relapse. Nevertheless, they also indicate that a minority of patients may not relapse over midterm and that those who have relapsed may have benefited from a drug-free period before being again treated for a new cycle of treatment. The most relevant question is thus whether in those patients with a low to medium risk of disease relapse, treatment withdrawal could be contemplated. In this specific setting, there may be pros and cons for anti-TNF withdrawal. Among the pros are the potential side effects and toxicity of anti-TNF, the risk of loss of response over time, the patient preference allowing the patient to regain control of one’s health and investing in it, also improving adherence, the absence of a negative impact on disease evolution of a transient anti-TNF withdrawal, and finally the cost. Key Messages: Although anti-TNF withdrawal in patients with sustained clinical remission is associated with a high risk of relapse, this risk seems to be much lower in a subgroup of patients, particularly in endoscopic and biologic remission. Stopping anti-TNF in this subgroup of patients may be associated with a favorable benefit/risk ratio.","PeriodicalId":13605,"journal":{"name":"Inflammatory Intestinal Diseases","volume":"12 1","pages":"64 - 68"},"PeriodicalIF":0.0,"publicationDate":"2021-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75808634","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":"Living with Ulcerative Colitis in Japan: Biologic Persistence and Health-Care Resource Use.","authors":"Danielle Bargo,&nbsp;Theo Tritton,&nbsp;Joseph C Cappelleri,&nbsp;Marco DiBonaventura,&nbsp;Timothy W Smith,&nbsp;Takanori Tsuchiya,&nbsp;Sean Gardiner,&nbsp;Irene Modesto,&nbsp;Tim Holbrook,&nbsp;Daniel Bluff,&nbsp;Taku Kobayashi","doi":"10.1159/000519123","DOIUrl":"https://doi.org/10.1159/000519123","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to improve understanding of adherence and persistence to biologics, and their association with health-care resource utilization (HCRU), in Japanese patients with moderate to severe ulcerative colitis (UC).</p><p><strong>Methods: </strong>Data were from Medical Data Vision, a secondary care administrative database. A retrospective, longitudinal cohort analysis was conducted of data from UC patients initiating biologic therapy between August 2013 and July 2016. Data collected for 2 years prior (baseline) and 2 years after (follow-up) the index date were evaluated. Patients completing biologic induction were identified, and adherence/persistence to biologic therapy calculated. HCRU, steroid, and immunosuppressant use during baseline and follow-up were assessed. Biologic switching during the follow-up was evaluated. Descriptive statistics (e.g., means and proportions) were obtained and inferential analyses (from Student's <i>t</i> tests, Fisher's exact tests, χ² tests, the Cox proportional hazard model, and negative binomial regression) were performed.</p><p><strong>Results: </strong>The analysis included 649 patients (adalimumab: 265; infliximab: 384). Biologic induction was completed by 80% of patients. Adherence to adalimumab was higher than that to infliximab (<i>p</i> < 0.001). Persistence at 6, 12, 18, and 24 months was higher with infliximab than with adalimumab (<i>p</i> < 0.05). Overall, gastroenterology outpatient visits increased, and hospitalization frequency and duration decreased, from baseline to follow-up. UC-related hospitalizations were fewer and shorter, and endoscopies fewer, in persistent than in nonpersistent patients, although persistent patients made more outpatient visits than nonpersistent patients. Hospitalization duration was lower in persistent than nonpersistent patients. Approximately 50% of patients received an immunosuppressant during biologic therapy; 5% received a concomitant steroid during biologic therapy. Overall, 17% and 3% of patients, respectively, received 2nd line and 3rd line biologics.</p><p><strong>Conclusions: </strong>Poor biologic persistence was associated with increased non-medication-associated HCRU. Effective treatments with high persistence levels and limited associated HCRU are needed in UC.</p>","PeriodicalId":13605,"journal":{"name":"Inflammatory Intestinal Diseases","volume":"6 4","pages":"186-198"},"PeriodicalIF":0.0,"publicationDate":"2021-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8739862/pdf/iid-0006-0186.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39863390","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":"Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as Noninvasive Predictors of the Therapeutic Outcomes of Systemic Corticosteroid Therapy in Ulcerative Colitis.","authors":"Katsuya Endo,&nbsp;Tomonori Satoh,&nbsp;Yuki Yoshino,&nbsp;Shiho Kondo,&nbsp;Yoko Kawakami,&nbsp;Tomofumi Katayama,&nbsp;Yoshiteru Sasaki,&nbsp;Atsuko Takasu,&nbsp;Takayuki Kogure,&nbsp;Morihisa Hirota,&nbsp;Takayoshi Meguro,&nbsp;Kennichi Satoh","doi":"10.1159/000520523","DOIUrl":"https://doi.org/10.1159/000520523","url":null,"abstract":"<p><strong>Introduction: </strong>Predictive biomarkers for the therapeutic outcome of induction therapy with systemic corticosteroid for active ulcerative colitis (UC) have not been established. This study aimed to investigate whether neutrophil-to-lymphocyte ratio (NLR) and/or platelet-to-lymphocyte ratio (PLR) can be predictive biomarkers for the therapeutic outcomes of systemic corticosteroid therapy in UC.</p><p><strong>Methods: </strong>This was a single-center retrospective cohort study. In total, 48 patients with UC who received induction therapy with systemic corticosteroid were enrolled. Based on the achievement of clinical remission after 8 weeks of treatment, the patients were divided into the remission group (<i>n</i> = 28) and the nonremission group (<i>n</i> = 20). Clinical characteristics, NLR, and PLR at baseline between the remission and nonremission groups were compared via a univariate analysis. The independent risk factors of nonremission were identified via a multivariate analysis.</p><p><strong>Results: </strong>The baseline Mayo score, platelet count, lymphocyte count, C-reactive protein (CRP) levels, NLR, and PLR between the 2 groups significantly differed. The nonremission group had higher NLR and PLR than the remission group (4.70 [3.04-11.3] vs. 3.10 [1.36-16.42]; <i>p</i> < 0.05, and 353.6 [220.3-499.8] vs. 207.2 [174.4-243.6]; <i>p</i> < 0.001, respectively). A multivariate analysis revealed that a Mayo score of ≥9, CRP level of ≥1.26 mg/dL, and PLR of ≥262 (hazard ratio: 23.1, 95% confidence interval: 1.29-413.7, <i>p</i> = 0.033) were considered independent risk factors for nonremission.</p><p><strong>Conclusion: </strong>This report first identified the efficacy of NLR and PLR as candidate biomarkers for predicting the therapeutic outcomes of systemic corticosteroid therapy in UC.</p>","PeriodicalId":13605,"journal":{"name":"Inflammatory Intestinal Diseases","volume":"6 4","pages":"218-224"},"PeriodicalIF":0.0,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8740212/pdf/iid-0006-0218.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39863393","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":"Dedicated Psychiatry Clinic for Inflammatory Bowel Disease Patients Has a Positive Impact on Depression Scores.","authors":"Kaleb Bogale,&nbsp;Sanjay Yadav,&nbsp;August Stuart,&nbsp;Allen R Kunselman,&nbsp;Shannon Dalessio,&nbsp;Nana Bernasko,&nbsp;Andrew Tinsley,&nbsp;Kofi Clarke,&nbsp;Emmanuelle Williams,&nbsp;Matthew D Coates","doi":"10.1159/000520797","DOIUrl":"https://doi.org/10.1159/000520797","url":null,"abstract":"<p><strong>Background: </strong>Psychiatric disorders, including anxiety and depression, are significantly more common in patients with inflammatory bowel disease (IBD). We established an integrated psychiatry clinic for IBD patients at our tertiary center IBD clinic to provide patients with critical, but frequently unavailable, coordinated mental health services. We undertook this study to evaluate the impact of this service on psychiatric outcomes, quality of life, and symptom experience.</p><p><strong>Methods: </strong>We performed a longitudinal prospective study comparing patients who had been cared for at our integrated IBD-psychiatry clinic to those who had not. We abstracted demographic and clinical information as well as contemporaneous responses to validated surveys.</p><p><strong>Results: </strong>Thirty-six patients cared for in the IBD psychiatry clinic were compared to a control cohort of 35 IBD patients. There was a significant reduction in the Hospital Anxiety and Depression Scale (HADS) depression score over time in the study cohort (<i>p</i> = 0.001), though not in the HADS anxiety score. When compared to the control group, the study cohort showed a significant reduction in the HADS depression score. No significant differences were observed in the Harvey-Bradshaw Index, Simple Clinical Colitis Activity Index, or Short IBD Questionnaire.</p><p><strong>Conclusions: </strong>This is the first study to evaluate the impact of an integrated psychiatry clinic for IBD patients. Unlike their control counterparts, individuals treated in this clinic had a significant reduction in the mean HADS depression score. Larger scale studies are necessary to verify these findings. However, this study suggests that use of an integrated psychiatry IBD clinic model can result in improvement in mental health outcomes, even in the absence of significant changes in IBD activity.</p>","PeriodicalId":13605,"journal":{"name":"Inflammatory Intestinal Diseases","volume":"7 2","pages":"81-86"},"PeriodicalIF":0.0,"publicationDate":"2021-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9c/fc/iid-0007-0081.PMC9294925.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40706569","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":"Behcet's Disease: An In-Depth Review about Pathogenesis, Gastrointestinal Manifestations, and Management.","authors":"Anthony Nguyen,&nbsp;Shubhra Upadhyay,&nbsp;Muhammad Ali Javaid,&nbsp;Abdul Moiz Qureshi,&nbsp;Shahan Haseeb,&nbsp;Nismat Javed,&nbsp;Christopher Cormier,&nbsp;Asif Farooq,&nbsp;Abu Baker Sheikh","doi":"10.1159/000520696","DOIUrl":"https://doi.org/10.1159/000520696","url":null,"abstract":"<p><strong>Background: </strong>Behcet's disease (BD) is a complex inflammatory vascular disorder that follows a relapsing-remitting course with diverse clinical manifestations. The prevalence of the disease varies throughout the globe and targets different age-groups. There are many variations of BD; however, intestinal BD is not only more common but has many signs and symptoms.</p><p><strong>Summary: </strong>BD is a relapsing-remitting inflammatory vascular disorder with multiple system involvement, affecting vessels of all types and sizes that targets young adults. The etiology of BD is unknown but many factors including genetic mechanisms, vascular changes, hypercoagulability, and dysregulation of immune function are believed to be responsible. BD usually presents with signs and symptoms of ulcerative disease of the small intestine; endoscopy being consistent with the clinical manifestations. The mainstay of treatment depends upon the severity of the disease. Corticosteroids are recommended for severe forms of the disease and aminosalicylic acids are used in maintaining remission in mild to moderate forms of the disease.</p><p><strong>Key messages: </strong>In this review, we have tried to summarize in the present review the clinical manifestations, differential diagnoses, and management of intestinal BD. Hopefully, this review will enable health policymakers to ponder over establishing clear endpoints for treatment, surveillance investigations, and creating robust algorithms.</p>","PeriodicalId":13605,"journal":{"name":"Inflammatory Intestinal Diseases","volume":"6 4","pages":"175-185"},"PeriodicalIF":0.0,"publicationDate":"2021-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8740277/pdf/iid-0006-0175.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39862415","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":"Mucosal Healing in Crohn’s Disease: Bull’s Eye or Bust? “The Pro Position”","authors":"N. O’Moráin, J. Doherty, R. Stack, G. Doherty","doi":"10.1159/000519521","DOIUrl":"https://doi.org/10.1159/000519521","url":null,"abstract":"Background: Crohn’s disease (CD) is a chronic inflammatory disorder affecting the gastrointestinal tract with disease behaviour based on the depth and severity of mucosal injury. Cumulative injury can result in complications including stricture formation and penetrating complications which often require surgical resection of diseased segments of the intestine resulting in significant morbidity. Accurate assessment of disease activity and appropriate treatment is essential in preventing complications. Summary: Treatment targets in the management of CD have evolved with the advent of more potent immunosuppressive therapy. Targeting the resolution of sub-clinical inflammation and achieving mucosal healing is associated with the prevention of stricturing and penetrating complications. Identifying non-invasive modalities to assess mucosal healing remains a challenge. Key Messages: Mucosal healing minimizes the risk of developing disease complications, prolongs steroid-free survival, and reduces hospitalization and the need for surgical intervention.","PeriodicalId":13605,"journal":{"name":"Inflammatory Intestinal Diseases","volume":"9 1","pages":"36 - 41"},"PeriodicalIF":0.0,"publicationDate":"2021-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89472086","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}