International Urology and Nephrology最新文献

{"title":"Microbiology and risk factors for bacteremic urinary tract infection: insights from the largest urological center in Pakistan.","authors":"Shaista Nawaz, Zaheer Udin Baber, Sunil Kumar Dodani, Sana Jamil, Asma Nasim","doi":"10.1007/s11255-024-04357-2","DOIUrl":"https://doi.org/10.1007/s11255-024-04357-2","url":null,"abstract":"<p><strong>Background: </strong>Bacteremic urinary tract infections (bUTI) are associated with significant morbidity and mortality. This study aims to identify risk factors, pathogenic organisms, and resistance patterns in bUTI.</p><p><strong>Methods: </strong>This prospective cohort study was conducted at a tertiary care urology center. Patients with urinary tract infections (UTIs) with and without bacteremia were included. Demographics, clinical characteristics, comorbidities, and urological intervention history were compared between non-bacteremic and bacteremic groups. The microbiology of UTI and bUTI was also studied comparing the isolated organisms and their resistance patterns.</p><p><strong>Results: </strong>A total of 250 patients with urinary tract infection were included. Bacteremia was found in 32.4% of the patients. Median age was 52 years. Chronic liver disease (RR 18.978 CI 1.799-200.158) and raised median serum creatinine (RR = 1.368 95% CI 1.022-1.833) were independently associated with bUTI. E.coli was the predominant organism. Klebsiella species was found significantly high in bacteremic group. A very high rate of carbapenem resistance was observed in bacteremic Gram-negative organisms. We found high resistance of commonly used antibiotics in non-bacteremic than bacteremic group.</p><p><strong>Conclusion: </strong>Chronic liver disease, impaired renal function, and Klebsiella species infection increase bacteremia risk. Urgent action is needed to implement robust infection control and antibiotic stewardship programs to combat rising uropathogen resistance.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909674","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":"Clinical characteristics and risk factors analysis of bilateral renal tuberculosis.","authors":"Xiaoshan Li, Linping Qi, Xiumei Li, Lilong Ma, Shuyu Yang, Xueyi Huang, Weiping Li, Xiande Huang, Yindong Kang, Panfeng Shang","doi":"10.1007/s11255-024-04332-x","DOIUrl":"https://doi.org/10.1007/s11255-024-04332-x","url":null,"abstract":"<p><strong>Objective: </strong>To analyze and discuss the clinical characteristics and risk factors of bilateral renal tuberculosis.</p><p><strong>Methods: </strong>A retrospective study was performed on 446 patients who were diagnosed with renal TB. Among these patients, 69 patients with bilateral renal TB were selected as the observation group, and 377 patients with unilateral renal TB served as the control group. Logistic regression was used to analyze the age, sex, BMI, place of residence, comorbidities, time from onset to clinic visit, and treatment history to identify the risk factors for the occurrence of bilateral renal TB.</p><p><strong>Results: </strong>The univariate analysis showed that BMI (P = 0.003), place of residence (P = 0.048), combined with urinary calculi (P = 0.010), history of endoscopy (P < 0.001), and history of ureteral stenting (P < 0.001) were significantly associated with the incidence of bilateral renal TB. The multivariate analysis revealed BMI < 18.5 kg/m² (OR = 2.282, 95% CI 1.197-5.154, P = 0.015), rural residence (OR = 2.353, 95% CI 1.115-4.966, P = 0.025), combined with urinary calculi (OR = 2.152, 95% CI 1.177-3.933, P = 0.013), and history of endoscopy (OR = 3.973, 95% CI 1.369-11.535, P = 0.011) were identified as independent risk factors for the occurrence of bilateral renal TB.</p><p><strong>Conclusion: </strong>Such factors as rural residence, low BMI, urinary calculi, and previous history of endoscopic examination were identified as the main risk factors for the occurrence of bilateral renal TB.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909725","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":"Screening for nasal carriage of Staphylococcus (S.) aureus reduces the risk of S. aureus peritonitis in patients on peritoneal dialysis (PD).","authors":"Gaetano Alfano, Michele Pittiglio, Camilla Ferri, Roberta Romaniello, Giuseppe Oliviero, Ylenia Cancelli, Laura Melara, Laura Tonelli, Martina Montani, Davide Raimondo, Niccolò Morisi, Giulia Ligabue, Silvia Giovanella, Francesco Fontana, Riccardo Magistroni, Gabriele Donati","doi":"10.1007/s11255-024-04309-w","DOIUrl":"https://doi.org/10.1007/s11255-024-04309-w","url":null,"abstract":"<p><strong>Introduction: </strong>Screening for nasal carriage of Staphylococcus (S.) aureus is associated with a reduction of peritoneal dialysis (PD)-related infections, but conflicting results have questioned the benefit of this practice. This study evaluated the clinical effectiveness of the screening program for nasal carriage of S. aureus in reducing the peritonitis rate in the PD population.</p><p><strong>Methods: </strong>A single-center retrospective study was conducted on all patients on PD diagnosed with peritonitis from 1999 to 2023. From 2011, screening for S. aureus with nasal swabs was implemented in our program. It was performed before the start of PD and in any case of peritonitis. Consequently, the study period was divided into pre-screening (1999-2010) and screening (2011-2023) phases.</p><p><strong>Results: </strong>The study included 195 patients who experienced 345 peritonitis episodes. Median age was 67 years. The overall peritonitis rate was 0.21 episodes/patient-year. Post-screening, the S. aureus peritonitis rate decreased significantly from 0.036 to 0.009 episodes/patient-year (P < 0.001). The screening did not reduce the total episodes of peritonitis (0.23 vs. 0.19 episodes/patient-year). Indeed, the cumulative peritonitis rate difference between the two phases was not significant (P = 0.31). The screening of previously decolonized patients with S. aureus peritonitis showed that 50% of them were colonized by S. aureus and that recolonization frequently occured in this population. Multivariate regression analysis showed that S. aureus screening was the only protective measure to reduce the risk of S. aureus peritonitis (OR, 0.36; CI_95% 0.14-0.91; P = 0.03).</p><p><strong>Conclusions: </strong>In our center, screening for nasal carriage of S. aureus significantly reduced the incidence of S. aureus peritonitis but did not impact the overall peritonitis rate. Recolonization is a real event that warrants a better preventive strategy.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909675","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":"Vitamin D: an important treatment for secondary hyperparathyroidism in chronic kidney disease?","authors":"Jie Yu, Yulu Li, Bin Zhu, Jianqin Shen, Liying Miao","doi":"10.1007/s11255-024-04334-9","DOIUrl":"https://doi.org/10.1007/s11255-024-04334-9","url":null,"abstract":"<p><p>Secondary hyperparathyroidism (SHPT) is one of the most common complications of chronic kidney disease (CKD). Vitamin D levels begin to decrease in the early stages of CKD, and these vitamin D-related changes play a central role in the occurrence and development of SHPT. Vitamin D-based drugs, which inhibit parathyroid hormone secretion either directly or indirectly, are commonly used to treat SHPT. However, vitamin D-based drugs can also lead to a dysregulated balance between serum calcium and phosphorus, as well as other adverse reactions. Over the past several decades, researchers have conducted in-depth studies on the pathogenesis of SHPT, developed new vitamin D-based drugs, and explored combinatory methods to improve treatment efficacy for the disease. Here, we review vitamin D metabolism, the diagnosis of vitamin D deficiency in patients with CKD, the pathogenesis of SHPT, the pharmacological effects of vitamin D drugs, and the benefits and side effects of using vitamin D to treat SHPT.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909677","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":"Causal association of circulating immune cells with nephrotic syndrome: evidence from a two-sample Mendelian randomization study.","authors":"Sheng Li, Xing Zhou, Chengmeng Liu, Yijie Wang, Qianhui Zhou, Ting Sun","doi":"10.1007/s11255-024-04350-9","DOIUrl":"https://doi.org/10.1007/s11255-024-04350-9","url":null,"abstract":"<p><strong>Objective: </strong>Nephrotic syndrome, a debilitating manifestation of kidney disease, often arises from diverse glomerular disorders and is accompanied by notable comorbidities. Despite indications of an immunological etiology, the precise role of immune cells in its pathogenesis remains unclear. This study aimed to elucidate the causal relationships between circulating immune cell phenotypes and nephrotic syndrome using a rigorous bidirectional Mendelian randomization approach.</p><p><strong>Methods: </strong>We conducted a bidirectional Mendelian randomization analysis leveraging public genome-wide association studies (GWAS) datasets to investigate the causal links between 731 immune cell features and nephrotic syndrome. Our primary analysis employed inverse variance weighting (IVW), complemented by MR-Egger regression, simple model, weighted median method, and weighted model techniques to ensure robustness. Sensitivity analyses were performed to address potential biases arising from heterogeneity, horizontal pleiotropy, and single-nucleotide polymorphism (SNP) instability in nephrotic syndrome.</p><p><strong>Results: </strong>Among traits examined, 13 immune cell phenotypes were identified to have significant causal impacts on nephrotic syndrome (adjusted P >  < 0.05). Among these phenotypes, CD25 on unswitched memory B cell, CD25 on memory B cell, CD25 on CD24 + CD27 + B cell, CD25 on IgD-CD38-B cell, CD33dim HLA DR-Absolute Count, and CD127 on granulocyte emerged as causal risk factors, while seven circulating immune cell phenotypes, predominantly monocyte subsets, exhibited protective effects. Furthermore, the reverse Mendelian randomization analysis demonstrated significant effects of nephrotic syndrome on 27 immune phenotypes (P < 0.05).</p><p><strong>Conclusion: </strong>The genetic predictions indicate that multiple circulating immune cell phenotypes, particularly CD25 on specific B-cell subsets, serve as independent risk factors for the onset and progression of nephrotic syndrome. Conversely, monocytes expressing specific phenotypes may exert protective effects against the development of nephrotic syndrome. These findings offer a novel therapeutic approach for the prevention and treatment of nephrotic syndrome.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909723","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":"Low-frequency bladder vibration for the treatment of urinary tract infections in spinal cord injury patients with neurogenic bladder.","authors":"Yingying Zhang, Ping Cai, Xiaoyan Feng, Qian Yang, Haifang Wang","doi":"10.1007/s11255-024-04353-6","DOIUrl":"https://doi.org/10.1007/s11255-024-04353-6","url":null,"abstract":"<p><strong>Purpose: </strong>Evaluate if low-frequency bladder vibration (LFBV) combined with clean intermittent catheterization (CIC) alleviated urinary tract infections (UTIs) in spinal cord injury (SCI) patients with neurogenic bladder (NB).</p><p><strong>Methods: </strong>A single-blind randomized controlled trial was conducted. Patients who developed UTIs while rehabilitating from SCI were enrolled continuously between January 2021 and March 2023 and randomly assigned to the control or the intervention group. Patients in the intervention group received LFBV twice daily (5-10 Hz, 5-10 min each time) for 10 days. The primary endpoint was urinary leucocytes, and various other UTI indexes were also tracked. The follow-up lasted four weeks.</p><p><strong>Results: </strong>The control group (n = 44) and the intervention group (n = 43) were indistinguishable in the basic patient characteristics. Compared to the control group, the intervention group has significantly higher urinary leucocytes on day 2 and significantly lower urinary leucocytes and urinary bacteria on day 10. Four weeks after LFBV, the intervention group had significantly lower urinary leucocytes and post-void residual volume, fewer signs and symptoms of urinary tract infection, as well as significantly higher urine volume. There was no significant change in urinary red blood cells or occult blood due to LFBV.</p><p><strong>Conclusion: </strong>Applying LFBV to SCI/NB patients with UTIs is recommended.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909672","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":"Unsupervised clustering analysis of treatment strategies for elite female athletes with severe stress urinary incontinence: focusing on competition return and SUI improvement.","authors":"Nobuo Okui, Machiko Okui","doi":"10.1007/s11255-024-04337-6","DOIUrl":"https://doi.org/10.1007/s11255-024-04337-6","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate two primary outcomes in elite female athletes (EFAs) with severe stress urinary incontinence (SUI) 24 months post-intervention: return to elite-level competition and improvement in SUI symptoms. Clustering analysis was conducted to identify subgroups within the patient population and explore treatment efficacy.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 183 EFAs with severe SUI who underwent treatments including pelvic floor muscle training (PFMT), vaginal and urethral erbium laser (Fotona Laser), and mid-urethral sling (MUS) surgery. Clustering analysis was conducted using K-means to categorize patients, followed by multivariate regression and Random Forest to determine predictors.</p><p><strong>Results: </strong>Three distinct clusters were identified. PFMT frequency was the most significant predictor of both return to sports and SUI improvement across clusters. Cluster 0, characterized by younger participants, required interventions like MUS surgery and Fotona Laser for significant improvement. Cluster 2, with high PFMT adherence, showed the best improvement in pad test results (4.9 g) and the highest return to sports rate (85.9%). Fotona Laser was particularly effective in Cluster 2, with 91.3% of patients returning to sports within one year. In contrast, Cluster 1, which included older participants with more severe symptoms, demonstrated the least improvement and lowest return to sports rate (2.8%), likely due to lower PFMT frequency and inconsistent training.</p><p><strong>Conclusion: </strong>Clustering analysis effectively categorized EFAs with SUI, highlighting the critical role of personalized, intensive PFMT in achieving sports return and symptom improvement. Future research should validate findings in larger cohorts and integrate machine learning to refine personalized medicine.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903014","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":"Assessing patient satisfaction with hemodialysis and peritoneal dialysis care and associated factors in Iran.","authors":"Nastaran Nemati, Mahmood Yousefi, Fatemeh Keshvari-Shad, Soleiman Akbari, Eshagh Barfar","doi":"10.1007/s11255-024-04346-5","DOIUrl":"https://doi.org/10.1007/s11255-024-04346-5","url":null,"abstract":"<p><strong>Purpose: </strong>With the increasing demand for dialysis, there is a growing emphasis on patient-centered care. This study investigated patients' satisfaction levels with peritoneal dialysis (PD) and hemodialysis (HD) care in Iran.</p><p><strong>Methods: </strong>A cross-sectional multicenter study was conducted among 346 patients with chronic kidney disease (CKD) covered by the Iran Health Insurance Organization who received dialysis services from October to December 2022 across the country. Data were gathered using a self-made questionnaire through telephone interviews. Data analysis included descriptive statistics, t tests, ANOVA, and linear logistic regression using R software.</p><p><strong>Results: </strong>Patients reported high satisfaction with doctors and nurses, health care facilities, and costs. PD patients had higher overall satisfaction (P < 0.001) and were more satisfied with costs (P < 0.001), while HD patients reported greater satisfaction with doctor and nurse behavior (P = 0.012). Significant factors associated with satisfaction included marital status (P = 0.012), insurance coverage duration (P = 0.027), dialysis type (P < 0.001), and time to dialysis initiation (P = 0.027). Doctor and nurse behavior had the greatest impact on satisfaction (P < 0.001).</p><p><strong>Conclusion: </strong>While patients were generally satisfied with the care provided, the findings revealed areas for improvement, particularly regarding the availability of medical centers and costs among dialysis patients. Focusing on patient education, communication, and supportive insurance policies has the potential to significantly enhance patient satisfaction and improve quality of life for dialysis patients.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894418","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":"Medical malpractice related to urology: an analysis of court decisions in Turkey.","authors":"Umit Uysal, Murat Ucar","doi":"10.1007/s11255-024-04354-5","DOIUrl":"https://doi.org/10.1007/s11255-024-04354-5","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study is to examine the lawsuits filed against urologists in Turkey, to reveal the results of these lawsuits and the sub-branch of urology they are related to, to discuss the possible reasons for the lawsuits and what can be done to prevent them.</p><p><strong>Materials and methods: </strong>The case outcomes obtained using the keyword \"Urology\" from the publicly accessible official website of the Presidency of the Supreme Court of the Republic of Turkey between 2018 and 2024 were analyzed by two expert urologists.</p><p><strong>Results: </strong>Of the 215 cases reviewed, the outcomes of 25 cases that met our inclusion criteria were analyzed. Sixteen of these cases were filed against private hospitals. Fourteen of the Supreme Court rulings involved civil (compensation) lawsuits, while 11 were criminal cases. Thirteen cases were related to endourology, and 9 patients had urinary system stone disease. Seventeen of the lawsuits involved allegations of postoperative medical errors. Five cases were attributed to procedural skill errors, and four were due to a lack of informed consent. Complications led to the death of seven patients. The decisions of the first-instance courts resulted in 12 acquittals, 7 compensation rulings, and 6 criminal convictions. At the Supreme Court level, 12 cases were ruled against the physicians.</p><p><strong>Conclusions: </strong>Nearly half of the cases resulted in rulings against urologists, with the majority being related to endourology. Our study emphasizes the importance of adhering to international medical guidelines, providing informed consent to patients, and carefully conducting postoperative follow-ups.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894377","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":"TITAL: targeting renal fibrosis with sulforaphane-a promising therapeutic strategy.","authors":"Hussain Ramzan, Humaira Kousar, Azeem Rab Nawaz","doi":"10.1007/s11255-024-04352-7","DOIUrl":"https://doi.org/10.1007/s11255-024-04352-7","url":null,"abstract":"<p><p>Renal fibrosis is a hallmark of chronic kidney disease, characterized by the excessive accumulation of extracellular matrix proteins. Sulforaphane, a potent antioxidant found in cruciferous vegetables, has shown promise in targeting renal fibrosis. By inhibiting fibrotic pathways, such as TGF-β signaling, and promoting antioxidant defenses, sulforaphane may offer a novel therapeutic strategy for mitigating kidney damage and slowing disease progression. Further research is needed to fully explore its therapeutic potential.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894433","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}