International Urogynecology Journal最新文献

{"title":"Comment on \"Gestational Diabetes Mellitus Affects the Risk of Obstetric Anal Sphincter Injury: A Systematic Review and Meta-Analysis of Cohort Studies\".","authors":"Ella Eg Fabricius, Thomas Bergholt, Hanna Jangö","doi":"10.1007/s00192-025-06095-0","DOIUrl":"https://doi.org/10.1007/s00192-025-06095-0","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does a Linear Array of Pressure Sensors Placed within the Vagina Really Measure the Ability of the Pelvic Floor to Respond to Increases in Intra-abdominal Pressure During High-Impact Activities?","authors":"Marina Petter Rodrigues, Sabine Vesting, Linda McLean","doi":"10.1007/s00192-025-06103-3","DOIUrl":"https://doi.org/10.1007/s00192-025-06103-3","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Mesh-Tissue Integration in Menopausal Models Using a Platelet-Rich Plasma-Decellularized Amnion Scaffold Sandwich: A Study on Mesh Contraction, Inflammatory Infiltrate, IL-17, CD31, and Collagen Deposition.","authors":"Alfa Putri Meutia, Pribakti Budinurdjaja, Amir Fauzi, Arief Boediono, Suskhan Djusad, Joedo Prihartono, Puspita Eka Wuyung, Andon Hestiantoro, Budi Iman Santoso","doi":"10.1007/s00192-025-06084-3","DOIUrl":"https://doi.org/10.1007/s00192-025-06084-3","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Mesh-augmented surgery in urogynecology involves the use of surgical mesh to support and reinforce weakened pelvic tissue. Although it can be effective, there are potential complications, including mesh extrusion and dyspareunia related to excessive inflammatory response. One possible approach to preventing excessive inflammation and promoting mesh-tissue integration is to utilize a mesh sandwiched between two layers of platelet-rich plasma-decellularized amnion scaffold (PRP-DAS).</p><p><strong>Methods: </strong>This experimental study was performed on 24 menopausal rabbit models. The treatment group consisted of a polypropylene (PP) mesh coated with PRP-DAS on both sides, whereas the control group included a PP mesh without PRP-DAS. Mesh-tissue integration was evaluated through macroscopic, histological, and immunohistochemical analyses. Macroscopic assessment focused on mesh extrusion and contraction, whereas histology and immunohistochemistry were done by assessing inflammatory response (inflammatory infiltrates [ININ] and interleukin-17 [IL-17] expression), neovascularization (angiogenesis score and cluster of differentiation 31/CD31 expression) and collagen deposition using image J on days 14, 28, and 90 following mesh implantation. Data were analyzed using one-way ANOVA followed by Tukey post hoc test.</p><p><strong>Results: </strong>Results demonstrated that no mesh extrusion was found in either group; however, mesh contraction was significantly lower in the PRP-DAS group than in controls. On days 28 and 90, ININ was significantly lower (p < 0.01; p = 0.011) and IL-17 expression was markedly elevated (p < 0.01) in the PRP-DAS group compared with the controls. Moreover, collagen deposition was significantly higher (p < 0.01) in the PRP-DAS group by day 90.</p><p><strong>Conclusion: </strong>The PRP-DAS sandwich prevents excessive inflammatory response and enhanced mesh-tissue integration in the menopausal rabbit model.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Outcomes of Transvaginal Sacrospinous Ligament Suture Rectopexy.","authors":"Henry H Chill, Alireza Hadizadeh, Angela Leffelman, Claudia Paya Ten, Cecilia Chang, Roger P Goldberg, Ghazaleh Rostaminia","doi":"10.1007/s00192-025-06099-w","DOIUrl":"https://doi.org/10.1007/s00192-025-06099-w","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Obstructed defecation syndrome (ODS) is characterized by a combination of straining, incomplete evacuation, and the use of digital manipulation with defecation. Transvaginal sacrospinous ligament suture rectopexy has been shown to effectively improve obstructed defecation symptoms caused by rectal partial prolapse and lack of support during first year postoperatively. This study aimed to investigate the long-term clinical and anatomical outcomes of this novel and minimally invasive surgery.</p><p><strong>Materials and methods: </strong>This longitudinal prospective cohort study was performed at a tertiary, university-affiliated pelvic health clinic. Women who underwent transvaginal sacrospinous rectopexy for treatment of ODS and for whom time since their surgery was at least 12 months were eligible for inclusion. Patients were contacted via telephone and were offered to come for an in-person evaluation, including symptom assessment (ODS symptoms, PFDI-20 and PGI-I questionnaires), POP-Q evaluation, and 3D dynamic ultrasound for assessment of rectal hypermobility. Clinical success was defined as not having any ODS symptoms (straining, incomplete emptying, or need to splint) in over 50% of bowel movements. Anatomical success was defined as not having rectal prolapse and compression ratio on ultrasound assessment of less than 50%.</p><p><strong>Results: </strong>A total of 135 patients were eligible for inclusion, out of which 65 patients, averaging 63.3 ± 13.3 years in age and 27.1 ± 5.6 in body mass index (BMI), were recruited. Median follow-up time was 29 months. Subjective failure was noted in 18 patients (28.1%) who experienced symptoms in more than 50% of bowel movements. Anatomical failure, defined as having a compression ratio of more than 50% or rectal prolapse, was noted in seven patients (12.7%). Three patients failed treatment with a recurrence of rectal prolapse and two patients underwent ventral mesh rectopexy within 1 year after surgery. Ultrasound measurements revealed that compression ratio significantly reduced from 52.9% ± 24.7 to 17.7% ± 12.3 (p < 0.001), indicating substantial anatomical improvements during the follow-up period.</p><p><strong>Conclusion: </strong>In conclusion, this study indicates that transvaginal sacrospinous ligament rectopexy is a safe, feasible, and minimally invasive effective alternative for treating ODS.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Comment on \"Short-Term Complications of Concomitant Pelvic Organ Prolapse and Rectal Prolapse Repair: A Systematic Review and Meta-Analysis\".","authors":"Alireza Hadizadeh, Henry H Chill, Angela Leffelman, Claudia Paya-Ten, Cecilia Chang, Roger P Goldberg, Steven D Abramowitch, Ghazaleh Rostaminia","doi":"10.1007/s00192-025-06092-3","DOIUrl":"https://doi.org/10.1007/s00192-025-06092-3","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Efficacy and Safety of Hyaluronic Acid Injection for Volume Restoration of the Labia Majora: ESOLANE study.","authors":"Fabien Boucher, Catherine Eychenne, Brice Gurriet, Nicolas Berreni, Juan Berrocal, Phryné Foulc, Alain Levy, Adriana Guzman-Ruiz, Barbara Hersant","doi":"10.1007/s00192-025-06094-1","DOIUrl":"https://doi.org/10.1007/s00192-025-06094-1","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Labia majora atrophy and protrusion of the labia minora beyond the labia majora is a concern for an increasing number of women who consider it aesthetically and, sometimes, functionally unsatisfactory. The ESOLANE study was a multicenter clinical investigation designed to collect effectiveness and safety data on DESIRIAL® PLUS injected subcutaneously in the labia majora in participants seeking labia majora volume deficits correction.</p><p><strong>Methods: </strong>A prospective, uncontrolled, open-label multicenter study was conducted between November 2019 and December 2021. Seventy-three women with labia majora hypotrophy or atrophy and requesting labia majora volume restoration were enrolled and 72 were treated. Outcome measures were collected at baseline, then 4, 12, 24, 36, and 52 weeks post treatment. Primary endpoint was the proportion of patients' who reported aesthetic improvement on the global aesthetic improvement scale (GAIS) 12 weeks after initial injection. Secondary endpoints were assessments of patients' and investigators' who reported GAIS, patient sexual function and physical symptoms, patient satisfaction, and safety.</p><p><strong>Results: </strong>According to the patients' who reported GAIS, 97% rated themselves as improved 12 weeks following the initial treatment. Improvement levels were high throughout the 52-week follow-up period with rates > 92%. Improvements were also confirmed on investigators' assessments with rates > 86%. Furthermore, patients reported significantly improved sexual function, symptom reduction, and high satisfaction. DESIRIAL® PLUS was well tolerated.</p><p><strong>Conclusions: </strong>DESIRIAL® PLUS is an effective and safe treatment option in patients with labia majora hypotrophy or atrophy. This effect goes beyond aesthetic improvement, as treatment was associated with improvement in patients' physical symptoms and sexual function.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, Attitude, and Practice Toward Urinary Incontinence Among Physically Active Women.","authors":"Jucyara da Silva Coelho, José Ananias Vasconcelos Neto, Camila Teixeira Moreira Vasconcelos, Simony Lira do Nascimento, Flávio Mendes Alves","doi":"10.1007/s00192-025-06093-2","DOIUrl":"https://doi.org/10.1007/s00192-025-06093-2","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Urinary incontinence (UI) is a prevalent condition that can impact the quality of life of physically active women. This study aimed to evaluate knowledge, attitudes, and practices (KAP) related to UI among women who exercise in gyms.</p><p><strong>Methods: </strong>A cross-sectional observational study was carried out from March to July 2022, in gyms located in the city of Parnaíba, in northeastern Brazil with physically active women. For data collection, the International Physical Activity Questionnaire (IPAQ), the International Incontinence Consultation Questionnaire-Short Form (ICIQ-SF), a specific KAP-UI questionnaire and a standardized form for sociodemographic, gynecological and obstetric data were used. The Mann-Whitney test, Fisher's exact test and chi-square tests were performed to analyze differences between subgroups formed on the basis of the presence or absence of urinary incontinence.</p><p><strong>Results: </strong>The research included 256 female participants with a median age of 33 (18-67) years, good education (≥ 12 years of studies) (97%), majority single (60%), and monthly income greater than US$ 235.51 (68%). The prevalence of UI was 43% (n = 110) with a moderate impact on quality of life. Among the participants, 51.8% had adequate knowledge and 98.7% demonstrated positive attitudes toward UI. However, only 29.5% adopted treatment practices, while preventive practices were carried out by only 16.4%. Factors significantly associated with inadequate knowledge included lower levels of education (p = 0.030), single marital status (p = 0.031), monthly income below US$235.51 (p = 0.019), and bodybuilding as the main physical activity (p = 0.039). Conversely, women who were highly physically active were more likely to have adequate knowledge. Significant associations were found between adequate knowledge and preventive and therapeutic practices (p = 0.003), as well as between inadequate knowledge and inadequate practices.</p><p><strong>Conclusions: </strong>Although only half of the participants had adequate knowledge about UI, the majority demonstrated a positive attitude toward the health problem. However, preventive practices were low among women without UI, as was the search for treatment among those with UI. Factors such as age, education, marital status, income, type and level of physical activity were linked to knowledge and preventive and treatment practices. Adequate knowledge was associated with effective preventive and therapeutic practices for IU by physically active women.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic Venous Disorders are Associated with an Earlier Age-of-Onset in Females with Interstitial Cystitis/Bladder Pain Syndrome.","authors":"Amr S El Haraki, Rory Ritts, Mary Namugosa, John Regan, Benjamin Daniel, Robert Evans, Stephen J Walker","doi":"10.1007/s00192-025-06088-z","DOIUrl":"https://doi.org/10.1007/s00192-025-06088-z","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Pelvic venous disorders (PVDs) are a group of inter-related pathological diagnoses that can present with a range of symptoms including pelvic and urinary symptoms similar to those seen in interstitial cystitis/bladder pain syndrome (IC/BPS). The relationship between PVDs and IC/BPS in humans has yet to be evaluated. This study's objectives are to determine the prevalence of PVD in patients with IC/BPS and to identify associated characteristics.</p><p><strong>Methods: </strong>Charts from our study on patients with IC/BPS undergoing hydrodistension (HOD) were screened for those with an MRI or CT scan of the abdomen/pelvis. Imaging findings suggestive of PVD were noted. Information regarding anesthetic bladder capacity (BC), Hunner lesion (HL) status, results for validated IC/BPS symptoms, and patient reports of comorbid non-urological associated syndromes (NUAS) known to co-occur with IC/BPS were collected.</p><p><strong>Results: </strong>A total of 133 patients with IC/BPS had the appropriate studies for a diagnosis of PVD, of which 64 (48.1%) were positive. PVD-positive patients were younger at IC/BPS diagnosis (35.36 ± 12.47 vs 42.32 ± 14.53; p = 0.004), younger at most recent HOD (45.59 ± 13.18 vs 53.32 ± 13.71; p = 0.001), and had a lower BMI (27.88 ± 7.35 vs 32.18 ± 9.29; p = 0.004). No significant differences were noted in age at earliest HOD, smoking status, average BC, HL status, total number of HOD, total NUAS, or any of multiple reported comorbidities. Additionally, none of the average IC/BPS symptom scores were significantly different.</p><p><strong>Conclusions: </strong>Imaging findings suggestive of PVD are common in patients with IC/BPS and may be associated with an earlier onset of disease.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Controlled Trial of Instillation Protocols Prior to Intradetrusor OnabotulinumtoxinA.","authors":"Sarah A Ward, Annliz Macharia, Michele R Hacker, Eman A Elkadry, William D Winkelman","doi":"10.1007/s00192-025-06080-7","DOIUrl":"https://doi.org/10.1007/s00192-025-06080-7","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Achieving adequate pain relief is crucial for intradetrusor onabotulinumtoxinA treatments for idiopathic overactive bladder in office settings. The objective of this study was to determine whether buffered lidocaine bladder instillation provides better pain control than standard lidocaine prior to intradetrusor onabotulinumtoxinA injections.</p><p><strong>Methods: </strong>We conducted a prospective, double-blind, randomized controlled trial comparing two protocols. The standard protocol used a pre-procedure instillation of 50 ml of 1% lidocaine and 50 ml of 0.9% saline. The buffered lidocaine protocol used 50 ml of 1% lidocaine, 45 ml of 0.9% saline, and 5 ml of 8.4% sodium bicarbonate. Both protocols were administered 20 min before onabotulinumtoxinA injections. Female patients with a primary diagnosis of idiopathic overactive bladder were randomized. The primary outcome was procedural pain using a visual analog scale (VAS) measured in millimeters, with secondary outcomes of patient satisfaction and willingness to repeat the procedure.</p><p><strong>Results: </strong>Of the 76 patients enrolled, 38 were randomized to each group. Data were analyzed for 37 patients in the buffered lidocaine group, and 36 in the standard lidocaine group. Both groups had comparable baseline characteristics. There was no difference in median pain measured by VAS between the buffered (16 [9-40]) and standard (25 [15-55]) protocols (p = 0.21). The buffered group reported a higher, though not statistically significant, satisfaction rate (68% vs 39%, p = 0.08).</p><p><strong>Conclusion: </strong>Intradetrusor onabotulinumtoxinA injections are generally well tolerated among women with idiopathic overactive bladder. No difference was found between protocols, suggesting that buffered lidocaine instillation may not improve pain control among women with idiopathic overactive bladder, although we had insufficient power to detect a difference of the observed magnitude.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-Term Complications Following Transvaginal Sacrospinous Ligament Rectopexy: A Retrospective Cohort Study.","authors":"Alireza Hadizadeh, Henry H Chill, Angela Leffelman, Claudia Paya-Ten, Cecilia Chang, Jungeun Lee, Roger P Goldberg, Steven D Abramowitch, Ghazaleh Rostaminia","doi":"10.1007/s00192-025-06098-x","DOIUrl":"https://doi.org/10.1007/s00192-025-06098-x","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Obstructed defecation syndrome (ODS) affects over 12% of middle-aged women, characterized by excessive straining, incomplete evacuation, and splinting. Current surgical options such as ventral mesh rectopexy, though effective, involve risks associated with mesh use and abdominal entry. This study evaluates the short-term complications of transvaginal sacrospinous ligament rectopexy.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted at a tertiary medical center, including patients over 21 years who underwent transvaginal sacrospinous ligament suture rectopexy for ODS from January 2018 to May 2024. Demographic, intraoperative, and 30-day postoperative complication data were collected.</p><p><strong>Results: </strong>A total of 190 patients with a mean age of 62.3 years underwent transvaginal sacrospinous ligament suture rectopexy. Intraoperative complications were rare, with four rectal injuries: two occurred during posterior dissection, one due to aggressive posterior repair, and another was discovered during exploration for postoperative pain. All rectal injuries were managed successfully. One patient experienced significant intraoperative bleeding, resulting in a hematoma that required evacuation 5 days later. Postoperative urinary retention was the most common complication, affecting 29.8% of patients. This was associated with concurrent procedures, such as mid-urethral sling placement and anterior colporrhaphy. Reoperation within 30 days was necessary for six patients (3.7%): two for urinary retention due to sling-related issues, two for sacrospinous pain necessitating suture removal, and two for vaginal bleeding related to hematoma formation. No cases of surgical site infection, sepsis, or mortality were observed.</p><p><strong>Conclusions: </strong>Transvaginal sacrospinous ligament suture rectopexy appears to be a safe alternative for ODS treatment, with low short-term complication rates.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}