International Journal of STD & AIDS最新文献

{"title":"Gastrointestinal <i>Escherichia coli</i> in men who have sex with men: A systematic review.","authors":"Jim Abi Frem, Annie Russell, Colin Fitzpatrick, Deborah Williams, Daniel Richardson","doi":"10.1177/09564624241306847","DOIUrl":"10.1177/09564624241306847","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review aimed to explore any demographic, biological and behavioural characteristics of men who have sex with men (MSM) with diarrhoeagenic <i>E.coli</i>.</p><p><strong>Design/methods: </strong>We searched MEDLINE, EMBASE, and CINAHL for manuscripts published to March 2024. One author screened manuscript abstracts; two authors independently conducted a full text review. We only included primary data on gastrointestinal <i>E.coli</i> in MSM. Risk of bias was assessed independently by two authors using the Joanna Briggs Institute tools. This review was registered on PROSPERO(CRD42023455321).</p><p><strong>Results: </strong>Eleven manuscripts (cross-sectional studies (<i>n</i> = 8), case-series (<i>n</i> = 1), case-control study (<i>n</i> = 1), longitudinal study (<i>n</i> = 1)) from Europe (<i>n</i> = 7) Australia (<i>n</i> = 2), USA (<i>n</i> = 2) including 983 MSM with gastrointestinal <i>E.coli</i> published between 2014-2023 were included in this review. Demographic factors (living with HIV, using HIV-PrEP, using dating apps and working as airline crew, group sex, non-regular (casual) sexual partners); behavioural factors (non-regular sexual partners, non-condom use, oro-anal sex, penile-anal sex, use of sex toys, insertive and receptive fisting, scat play); and infection factors (co-infection with <i>Chlamydia trachomatis</i> including LGV, <i>Neisseria gonorrhoeae</i>, <i>Treponema pallidum</i>, hepatitis C, other enteric pathogens [<i>Shigella</i> spp. <i>Giardia duodenalis, Entamoeba histolytica</i>, hepatitis A and intestinal spirochaetosis]) were observed in MSM with <i>E. coli</i>. Antimicrobial resistance (extended spectrum beta-lactamase and quinolone resistance) was described in MSM with <i>E.coli</i>.</p><p><strong>Conclusion: </strong>We have highlighted demographic, behavioral and infection factors observed in MSM with <i>E.coli</i> suggesting sexual transmissibility. These data provide insight for future clinical guidelines, public health control strategies and research.</p>","PeriodicalId":14408,"journal":{"name":"International Journal of STD & AIDS","volume":" ","pages":"176-184"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging sexually transmitted infections outbreak: Dermatophytosis among men who have sex with men in Milan, Italy.","authors":"Chiara Maci, Angelo Roberto Raccagni, Riccardo Lolatto, Emanuela Messina, Diana Canetti, Chiara Tassan Din, Maria Del Carmen Garcia Martearena, Golnaz Torkjazi, Martina Bottanelli, Caterina Candela, Antonella Castagna, Silvia Nozza","doi":"10.1177/09564624241312731","DOIUrl":"10.1177/09564624241312731","url":null,"abstract":"<p><strong>Background: </strong>Dermatophytosis is an infection of the skin or adnexa, which is extremely widespread in the environment. Sexually transmitted infections (STIs) are an increasing global public health threat, especially among men who have sex with men (MSM). This study aims to describe an outbreak of sexually transmitted dermatophytosis among MSM in our cohort between April 2022 and October 2023.</p><p><strong>Methods: </strong>This is a retrospective monocentric study including outpatients who were diagnosed with at least one episode of dermatophytosis between March 2010 and October 2023 at the Infectious Diseases Unit of San Raffaele Scientific Institute, Milan, Italy. Mycosis diagnosis was mainly clinical following the medical visit and physical examination.</p><p><strong>Results: </strong>Overall, 107 people were diagnosed with dermatophytosis between March 2010 and October 2023. All 56 cases observed since April 2022 included 55 MSM and 1 female; compared to before 2022 there was a total diagnosis of 51 cases.</p><p><strong>Conclusions: </strong>These results highlight the evident increase in the incidence of mycotic infections among MSM, followed in our center. We are dealing with a new entity of sexually transmissible infections, in addition to the existing diseases that are being studied.</p>","PeriodicalId":14408,"journal":{"name":"International Journal of STD & AIDS","volume":" ","pages":"319-323"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness, safety, and patient-reported outcomes of bictegravir/emtricitabine/tenofovir alafenamide in routine clinical care in Italy: 12-Month results from the BICSTaR cohort.","authors":"Andrea Antinori, Giulia Marchetti, Vincenzo Esposito, Stefano Rusconi, Diana Canetti, Eugenia Quiros-Roldan, Bianca Candelaresi, Annalisa Saracino, Massimo Andreoni, Andrea Marongiu, Tali Cassidy, David Thorpe, Laura Albini, Roberto Caldera, Gabriele Forcina, Giovanni Di Perri","doi":"10.1177/09564624241308372","DOIUrl":"10.1177/09564624241308372","url":null,"abstract":"<p><strong>Background: </strong>BICSTaR is a multi-national, observational cohort evaluating the effectiveness, safety, and patient-reported outcomes (PROs) in treatment-naïve (TN) and -experienced (TE) people with HIV-1 receiving bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in routine clinical care. We present the 12-month (M12) outcomes of the Italian BICSTaR cohort.</p><p><strong>Methods: </strong>Participants initiating B/F/TAF in routine care were prospectively followed. Outcomes included virological and immunologic effectiveness, drug-related adverse events (DRAEs), treatment persistence, and PROs using the HIV Symptom Index (HIV-SI) and the HIV Treatment Satisfaction Questionnaires (HIVTSQ).</p><p><strong>Results: </strong><i>N</i> = 201 were included (29 TN, 172 TE), 83% male, median age 38 years in TN, 48 years in TE. At baseline, 94% of TE had an HIV-1 RNA <50 cp/mL, 92% switched to B/F/TAF for simplification. Overall, 69% reported comorbidities (TN: 59%, TE: 70%). At M12, 88% (23/26) of TN and 96% (152/159) of TE had an HIV-1 RNA <50 cp/mL in the discontinuation = failure analysis (without emergence of resistance to B/F/TAF). Median CD4 count changes were +296 cells/µL (interquartile range [IQR], 118, 383) in TN, and +23 cells/µl (-137, 114) in TE. DRAEs were reported for 5% and led to discontinuation in 1%. M12 persistence on B/F/TAF was 97%. TN had a median HIV-SI bothersome symptom count decrease of -1.5 (IQR, -5.0, 0.0). Median treatment satisfaction change score was +29.0 (21, 30) in TE indicating an improvement.</p><p><strong>Conclusions: </strong>In this real-world Italian cohort of mostly treatment-experienced people switching for simplification, B/F/TAF demonstrated high effectiveness and persistence over 12 months and confirmed the favourable safety profile shown in clinical trials.</p><p><strong>Trial registration: </strong>European cohort: EUPAS22185.</p>","PeriodicalId":14408,"journal":{"name":"International Journal of STD & AIDS","volume":" ","pages":"309-318"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated initial clavus-like rash: a rare presentation of secondary syphilis.","authors":"Yaqi Sun, Wei Zhao, Furong Li, Shengli Chen, Hongqing Tian","doi":"10.1177/09564624241309172","DOIUrl":"10.1177/09564624241309172","url":null,"abstract":"<p><p>We report two cases of secondary syphilis with an isolated papule on the palm as the initial presentation. The clinical manifestations of secondary syphilis can be diverse, with a high rate of misdiagnosis and underdiagnosis. This article presents two patients with a purpose to alert clinicians not to forget the great imitator of syphilis for lesions of uncertain diagnosis.</p>","PeriodicalId":14408,"journal":{"name":"International Journal of STD & AIDS","volume":" ","pages":"327-329"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High prevalence of hepatitis C virus infection among adolescents and young adults attending HIV and sexual health clinics.","authors":"Krisanee Pansue, Pathariya Promsena, Wipaporn Natalie Songtaweesin, Juthamanee Moonwong, Juliet Ryan, Surinda Kawichai, Kessarin Thanapirom, Thanyawee Puthanakit","doi":"10.1177/09564624241302231","DOIUrl":"10.1177/09564624241302231","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of hepatitis C virus (HCV) infection among Thai adults is 0.5%-1.0%. This study aims to determine the prevalence of HCV infection among adolescents and young adults (AYA) accessing HIV/sexual health clinics.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among AYA aged 15-24 years attending HIV/sexual health clinics in Bangkok, Thailand. The HCV infection prevalence, defined by anti-HCV antibody positivity using rapid diagnostic tests (SD BIOSENSOR, Korea), were reported with proportions and a 95% confidence interval (CI). Multivariate logistic regression was performed to identify factors associated with HCV infection.</p><p><strong>Results: </strong>From March to August 2023, 300 AYAs with a median age of 21 (interquartile range 20-23) years were enrolled into the study. One-third (29.7%) were people living with HIV (PLHIV). The overall prevalence of HCV infection was 2.7% (95%CI 1.2-5.2). Prevalence was higher among PLHIV (5.6%) compared to AYA without HIV (1.4%) (<i>p</i>-value 0.053). The factor most significantly associated with HCV infection was people who used drugs (adjusted odds ratio 15.3, 95% CI 2.9-82.0, <i>p</i>-value 0.001).</p><p><strong>Conclusions: </strong>History of drug use was associated with the highest HCV infection prevalence. PLHIV had a trend of higher prevalence. HCV screening in HIV/sexual health clinics is recommended for early detection, treatment, and transmission reduction.</p>","PeriodicalId":14408,"journal":{"name":"International Journal of STD & AIDS","volume":" ","pages":"289-296"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of topical potassium hydroxide 5% solution with cryotherapy in the treatment of patients with genital warts: A randomized controlled clinical trial.","authors":"Fateme Javame Ghazvini, Mohammad Javad Yazdanpanah, Yalda Nahidi, Shatila Torabi, Raheleh Ganjali, Amir Hoshang Mohammadpour, Seyyedeh Zahra Ghasemi","doi":"10.1177/09564624241300776","DOIUrl":"10.1177/09564624241300776","url":null,"abstract":"<p><strong>Background: </strong>Given the therapeutic challenge of wart treatment and the need for an ideal treatment that is effective, noninvasive, cost-effective, and has minimal side effects, this study aims to compare the local impact of a 5% potassium hydroxide (KOH) solution with cryotherapy, the current standard treatment for genital warts.</p><p><strong>Methods: </strong>Two groups, each consisting of 49 patients: the first group was treated with a daily topical application of 5% KOH solution using a swab, while the second group underwent cryotherapy in two 5-20 s freeze-thaw cycles. Before treatment, patient demographic data and number of lesions were recorded. Follow-up visits were conducted at four-week intervals for 12 weeks, during which the number of lesions, time to complete recovery, and skin-related side effects were examined and recorded, ensuring comprehensive data collection.</p><p><strong>Results: </strong>A total of 98 patients (average age: 28.40 ± 7.34 years), 55 cases (55.1%) being female and 43 cases (43.9%) being male. Importantly, there was no significant difference in terms of gender (<i>p</i> = .684), education (<i>p</i> = .533), and marital status (<i>p</i> = .703) between the two study groups. Further, no significant difference in previous infection history (<i>p</i> = .493) and partner infection (<i>p</i> = .098) was identified. There was no significant difference in terms of treatment response (<i>p</i> = .510) and relapse (<i>p</i> < .999) between the two KOH and cryotherapy study groups.</p><p><strong>Conclusion: </strong>The study found no significant differences in treatment response, relapse rates, or side effects between using 5% potassium hydroxide solution and cryotherapy for genital wart treatment. These findings suggest that both modalities offer comparable efficacy and safety profiles, providing clinicians with valuable options in tailoring treatment approaches for patients with genital warts.</p>","PeriodicalId":14408,"journal":{"name":"International Journal of STD & AIDS","volume":" ","pages":"205-211"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142728691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Doxycycline post-exposure prophylaxis for preventing bacterial sexually transmitted infections (STIs): Are clinical providers supportive?","authors":"Esma Imerlishvili, John Lake, Sara Todorovic, Charles Gonzalez, Elizabeth M Boos, Rachel Hart-Malloy","doi":"10.1177/09564624241309433","DOIUrl":"10.1177/09564624241309433","url":null,"abstract":"<p><strong>Background: </strong>Bacterial sexually transmitted infections (STIs) continue to increase in the United States. Despite evidence of the effectiveness of doxycycline post-exposure prophylaxis (Doxy-PEP) to prevent STIs, little is known about providers' attitudes and willingness to implement Doxy-PEP.</p><p><strong>Methods: </strong>An online questionnaire was sent to 575 clinical providers in New York State in September 2022.</p><p><strong>Results: </strong>Ninety-one eligible individuals responded. Most providers served men who have sex with men (MSM) (84%); reported willingness to recommend Doxy-PEP (98%, 77%, and 67% for chlamydia, syphilis, and gonorrhea, respectively); preferred Doxy-PEP administration for MSM and transgender populations; believed recurring bacterial STIs (88%) and reported condomless sex (85%) were the most important characteristics to consider for recommending Doxy-PEP; and were concerned about antibiotic resistance (90%) (primarily for <i>Neisseria gonorrhoeae</i>). Insurance costs were the most perceived community-associated barriers (35%). There were no significant differences in providers' recommendations towards Doxy-PEP use when comparing clinicians' years of experience, regions, or professional titles.</p><p><strong>Conclusions: </strong>Study results suggest high willingness and support for implementing Doxy-PEP. As this survey was administered prior to national guidelines on the use of Doxy-PEP, these data can be used as a baseline to compare to studies conducted after their release to formulate appropriate messages for providers to improve implementation.</p>","PeriodicalId":14408,"journal":{"name":"International Journal of STD & AIDS","volume":" ","pages":"297-303"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11993814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Effectiveness, safety, and patient-reported outcomes of bictegravir/emtricitabine/tenofovir alafenamide in routine clinical care in Italy: 12-Month results from the BICSTaR cohort\".","authors":"","doi":"10.1177/09564624251320827","DOIUrl":"10.1177/09564624251320827","url":null,"abstract":"","PeriodicalId":14408,"journal":{"name":"International Journal of STD & AIDS","volume":" ","pages":"341"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health service utilization among patients followed up in tertiary HIV/AIDS clinics in Turkey: A need for integrated care.","authors":"Ezgi Ince Guliyev, Dilek Yıldız Sevgi, Alper Gündüz, Bilgül Mete, Deniz Büyükgök, Hayat Kumbasar Karaosmanoğlu, Ozlem Altuntaş Aydın, Fatma Ceyhan, Bilge Nur Bilge, Irmak Polat, Fehmi Tabak","doi":"10.1177/09564624241301491","DOIUrl":"10.1177/09564624241301491","url":null,"abstract":"<p><strong>Objectives: </strong>Mental health (MH) care for people living with HIV (PLWH) emerges as an important unmet need, yet there are no integrated HIV-MH clinics in Turkey. Our aim is to determine MH service use and its associated factors in PLWH followed up in the HIV/AIDS outpatient clinics in Istanbul/Turkey.</p><p><strong>Methods: </strong>A cross-sectional study was conducted at the HIV/AIDS outpatient clinics of the Infectious Diseases (ID) departments in hospitals affiliated with the ACTHIV-IST Study Group. Structured interviews were performed using questionnaires that covered psychiatric state, medical history, and help-seeking behavior.</p><p><strong>Results: </strong>Out of 172 outpatients, 121 (70.3%) reported MH complaints after infection, and 65.6% felt a need to see MH professionals. Among those, 59% shared their MH distress with the ID team. However, only 20.7% applied to an MH service, and 16.5% received psychiatric treatment. Previous MH diagnoses (AOR = 4.11; 95%CI = 1.26-13.39), sharing the disease with the ID team (AOR = 4.18; 95%CI = 1.24-14.11), and being hospitalized due to HIV (AOR = 6.54; 95%CI = 1.21-35.39) emerged as the predictors of MH service use among those who would like to see an MH professional in logistic regression.</p><p><strong>Conclusions: </strong>Closer contact with the healthcare system may increase the chances of PLWH receiving MH care. Thus, integrating MH services in HIV/AIDS care would help reach more PLWH who are distressed.</p>","PeriodicalId":14408,"journal":{"name":"International Journal of STD & AIDS","volume":" ","pages":"185-194"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Let's get PrEP'd\" - A pilot service evaluation of the LVNDR health digital pre-exposure prophylaxis pathway for HIV prevention.","authors":"Joshua S Wells, Jennifer Ching, Araxie Boyadjian, Christopher El Badaoui","doi":"10.1177/09564624241303815","DOIUrl":"10.1177/09564624241303815","url":null,"abstract":"<p><strong>Background: </strong>Despite the availability of PrEP, 2023 data have demonstrated an increase in new HIV diagnoses. LGBTQ + individuals are disproportionately affected by HIV. PrEP access is crucial but limited due to high demand on sexual health services. Additional modalities of PrEP access may help to address this unmet need. LVNDR Health, a digital solution for LGBTQ + care, sought to evaluate its PrEP pathway.</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional service evaluation of users accessing the LVNDR digital PrEP pathway between December 2022-April 2023. Operational data (e.g., appointment attendance) were derived from the clinical dashboard. Service-user feedback (e.g., service experience) was sought using a bespoke questionnaire. Descriptive statistics are reported for socio-demographic information. Non-parametric between-group analyses are reported.</p><p><strong>Results: </strong>In total, 90 users completed the end-to-end pathway and received PrEP. Average time for pathway completion was 2.7 weeks. A survey response rate of 71.0% was achieved. Users reported significantly higher service satisfaction, inclusivity, and accessibility, compared to their most recent experience accessing PrEP (<i>p</i> < .01). Up to 89% of users strongly agreed they would switch to a digital PrEP service if made available.</p><p><strong>Conclusion: </strong>Digital PrEP shows acceptability among LGBTQ + populations. More research is needed to assess scalability, digital equity, and cost-effectiveness.</p>","PeriodicalId":14408,"journal":{"name":"International Journal of STD & AIDS","volume":" ","pages":"223-230"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}