Irish Journal of Medical Science最新文献

{"title":"Connected health in cancer survivorship: Evaluating the usability and utility of the cancer thriving and surviving programme in Ireland.","authors":"Isaiah Gitonga, Deirdre Desmond, Louise Mullen, Dorothy Thomas, Cathleen Osborne, Bernie O'Loughlin, Rebecca Maguire","doi":"10.1007/s11845-025-03931-6","DOIUrl":"https://doi.org/10.1007/s11845-025-03931-6","url":null,"abstract":"<p><strong>Background: </strong>Cancer survivorship care has become increasingly complex, with a growing population of people living with and beyond the disease requiring holistic support and follow-up. Connected health (CH) offer a promising solution to enhance care delivery.</p><p><strong>Aim: </strong>This study evaluated the usability and effectiveness of CH, and motivations of participants in the Cancer Thriving and Surviving (CTS) programme in Ireland.</p><p><strong>Methods: </strong>A cross-sectional survey of persons living with and beyond cancer (PLWBC) who completed the CH-delivered CTS was conducted between December 2022 and April 2023. Closed and open-ended questions captured participants experiences and motivations. Telehealth Usability Questionnaire (TUQ) assessed the CH usability. Qualitative content analysis examined recurring themes in participant responses.</p><p><strong>Results: </strong>Forty-four participants who engaged in CTS completed the survey. Participants were predominantly female (88%), diagnosed with breast cancer (76%), and had third-level education or higher (86%). Slightly over one third (36%) were in full time employment. Motivations for engaging in CTS included seeking peer support, psychosocial assistance, and practical self-management tools. Most respondents agreed that the programme improved their psychological wellbeing (90%), quality of life (76%) and helped them take more control of their health (83%). TUQ scores indicated high usability of the CH systems.</p><p><strong>Conclusion: </strong>Findings suggest that the CH-delivered CTS programme effectively benefits PLWBC, improving psychological well-being and quality of life. The high CH system usability and positive user experiences highlight its potential to complement in-person care, supporting the continued development and evaluation of CH systems to enhance cancer survivorship, particularly within Irish digital health initiatives.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673794","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":"Prognostic value of progesterone receptor expression in non-small cell lung cancer tissue.","authors":"Romanov I P, Bogush T A, Scherbakov A M, Grishanina A N, Bogush E A, Ravcheeva A B, Kosorukov V S","doi":"10.1007/s11845-025-03917-4","DOIUrl":"https://doi.org/10.1007/s11845-025-03917-4","url":null,"abstract":"<p><strong>Background: </strong>Progesterone receptors (PRs) play a role in the regulation of cell proliferation and are expressed in non-small cell lung cancer (NSCLC) tissue. Therefore, they represent a potential target for novel antitumor therapies. A survival analysis of NSCLC patients based on PR expression in tumor tissue may help assess the feasibility of using PR modulators in the treatment of this disease.</p><p><strong>Aim: </strong>This study aims to evaluate the prognostic significance of PR expression in NSCLC to determine the potential utility of PR modulators as a therapeutic strategy.</p><p><strong>Methods: </strong>PR expression was assessed in 130 surgically resected NSCLC samples using immunofluorescence analysis combined with flow cytometry. Primary antibodies against PR (NBP2-4638, Novus Biologicals, USA) and secondary antibodies conjugated with DyLight650 (ab98729, Abcam, UK) were used. The percentage of PR-expressing cells was quantified using FlowJo software. Statistical analyses were conducted in GraphPad Prism and RStudio using the \"survival\" package. The prognostic impact of PR expression in NSCLC tissue was evaluated in the overall patient cohort and after excluding censored events (n = 56) to minimize the influence of confounding factors on survival analysis.</p><p><strong>Results: </strong>After excluding censored events and stratifying patients based on the median PR expression level (57%), survival analysis revealed that high PR expression in NSCLC tissue is associated with a poorer prognosis (p = 0.05). Patients with high PR expression (≥ 57%) had a median survival of 12.8 months, whereas those with low PR expression (< 57%) had a median survival of 25.8 months (HR = 1.7).</p><p><strong>Conclusions: </strong>Elevated PR expression in NSCLC tumors is associated with reduced patient survival. These findings suggest that PR modulators may have potential therapeutic value for NSCLC patients with PR-positive tumors.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673854","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":"A 1-year review of anti-Ro/La autoantibody testing in an obstetric population.","authors":"Elizabeth Tunney, Clare M Crowley, Claire M McCarthy, Etaoin Kent","doi":"10.1007/s11845-025-03935-2","DOIUrl":"https://doi.org/10.1007/s11845-025-03935-2","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate current anti-Ro and anti-La autoantibody ordering patterns, clinical indications for performing these tests, and potential cost-benefit analysis.</p><p><strong>Methods: </strong>In this retrospective cohort study, patients who underwent autoantibody testing over 1 year were included. Necessary information was obtained from patient electronic records.</p><p><strong>Results: </strong>In total 47 patients underwent anti-Ro/La autoantibody testing. Of those tested, 11/47 (2%) had positive results and testing was clinically indicated in 26/47 (55%) patients, indicating minimal cost-benefits. The total rate of the cost prescription was €1644.96. The mean time to process tests was 5 days. In those with positive autoantibodies, two infants were diagnosed with congenital heart block and had pacemakers inserted after delivery.</p><p><strong>Conclusion: </strong>This study found anti-Ro/La autoantibody tests were appropriately ordered in accordance with clinical guidelines. By identifying patients who were autoantibody negative, economic benefits were gained, in terms of antenatal management including reduced frequency of antenatal visits and fetal heart surveillance.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673765","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":"How can physical activity promotion be optimised in general practice: a narrative review of the literature.","authors":"Stephen Dolan, Andrew O'Regan","doi":"10.1007/s11845-025-03932-5","DOIUrl":"https://doi.org/10.1007/s11845-025-03932-5","url":null,"abstract":"<p><strong>Background: </strong>Physical inactivity is a significant contributor to preventable chronic health conditions worldwide. General practice has been identified as a setting to improve physical activity levels through exercise promotion during consultations. However, physical activity promotion in general practice is unstructured and suboptimal.</p><p><strong>Aims: </strong>The aim of this study is to review the literature pertaining to factors that influence physical activity promotion in general practice and to answer the research question: what are the experiences of patients and GPs with physical activity promotion in consultations?</p><p><strong>Methods: </strong>Online databases were searched for relevant papers using predetermined inclusion and exclusion criteria. Papers retrieved were original research only, involving patients, general practitioners or practice nurses. A PRISMA approach to study selection was followed.</p><p><strong>Results: </strong>Of 464 papers retrieved, 20 were included in the review. Physical activity promotion is acceptable to patients but some do not appreciate its health benefits. A personalised approach is important to patients, including tailored advice and setting meaningful goals. Studies involving general practitioners and practice nurses report that they are aware of the importance of physical activity and their role in its promotion, but time is the primary barrier. Strategies identified include demedicalisation of physical activity, resources such as patient handouts as well as signposting to community initiatives, social prescribers and collaboration with exercise professionals.</p><p><strong>Conclusion: </strong>General practice has the potential to effectively promote physical activity but system- and practitioner-level changes are necessary to achieve meaningful change.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673853","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":"International surgical fellowships in the USA: the pathway to success.","authors":"Ian S Reynolds, Nicholas P McKenna, Kellie L Mathis, William R Perry","doi":"10.1007/s11845-025-03936-1","DOIUrl":"https://doi.org/10.1007/s11845-025-03936-1","url":null,"abstract":"<p><p>International surgical fellowships offer senior trainees the opportunity to experience alternative health systems and learn novel cutting-edge techniques. They might also offer trainees exposure to a job market that they had not considered before. Obtaining a surgical fellowship in a reputable North American institution has been the chosen pathway for generations of Irish surgical trainees, yet it is not always a straightforward pathway. The following manuscript highlights the necessary preparation and key steps required to be a successful candidate in the search for a fellowship. It details some key pieces of advice surrounding the application and interview process and provides some guidance on how to choose a programme that will best suit your needs and meet your expectations.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648473","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":"A scoping review of historical and contemporary management strategies for paediatric scrotal trauma.","authors":"Kenneth Patterson, Derek B Hennessey, Fardod O'Kelly","doi":"10.1007/s11845-025-03929-0","DOIUrl":"https://doi.org/10.1007/s11845-025-03929-0","url":null,"abstract":"<p><strong>Objective: </strong>To perform a scoping review of the literature pertaining to paediatric scrotal trauma and to contrast operative with conservative management in this cohort of patients using available data.</p><p><strong>Methods: </strong>A search of Cochrane, SCOPUS, and EMBASE databases was performed using methods pre-published on PROSPERO. Reporting followed Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Eligible studies were articles or abstracts published in English describing the management of paediatric scrotal trauma, which reported at least one secondary outcome. The intended primary analysis is to report the management of paediatric scrotal trauma and the outcome based on management.</p><p><strong>Results: </strong>Thirty-six studies were identified, totaling 253 patients. Then, 91.7% of cases presented with unilateral testicular injury and 94.5% of cases resulted from blunt trauma. Then, 86% of patients presenting with scrotal trauma underwent ultrasound imaging of the scrotum. One hundred twenty-three cases underwent conservative management, 116 cases underwent acute surgical management, and 14 underwent delayed surgical management, with a mean time to an intervention of 3 days. Thirty patients were found to have testicular atrophy, with a mean follow-up of 14 months, of these 30 patients, 63% (n = 19) were conservatively managed, 20% (n = 6) were managed with acute surgical repair, and 17% (n = 5) were managed with delayed surgical repair.</p><p><strong>Conclusion: </strong>Paediatric testicular trauma is a rare presentation. A high level of suspicion is mandatory when testicular rupture is suspected. Early exploration is warranted in the setting of high risk and provides an excellent chance of testicular salvage.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633949","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":"Microbiologic features of prosthetic joint infections at a tertiary referral orthopaedic unit.","authors":"Stephen Christopher Murphy, Shane P Russell, James A Harty, Padhraig O'Loughlin","doi":"10.1007/s11845-025-03933-4","DOIUrl":"https://doi.org/10.1007/s11845-025-03933-4","url":null,"abstract":"<p><strong>Background: </strong>Prosthetic joint infections (PJI) are a potential devasting consequence of arthroplasty surgery. Knowledge of the causative organism and antimicrobial sensitivity increases eradication success rates for PJI.</p><p><strong>Aims: </strong>This study aimed to: 1) Observe the PJI microbiome at a tertiary referral arthroplasty unit; 2) Make comparison to similar published observations; and; 3) Establish empiric local antibiotic PJI guidelines.</p><p><strong>Methods: </strong>All patients with positive tissue cultures for PJIs over a 4 year period were included. An electronic microbiology laboratory database search was performed to identify isolated microorganisms, sensitivities and resistances. Time from index procedure to PJI onset was recorded. The identified PJI microbiome was compared to current literature.</p><p><strong>Results: </strong>86 patients involving 88 joints were included. 56% (n = 49) related to hip, 42% (n = 37) to knee and 2% (2) to shoulder arthroplasty procedures. Coagulase Negative Staphylococci (CoNS) were isolated in 32% of cases, Staphylococcus aureus (SA) in 23%, Enterococcus species and Streptococcus species in 9.0%. 19% of case occurred within 3 months of index surgery, 17% from 3-12 months and 64% after 12 months. The microbiome identified varied comparable studies.</p><p><strong>Conclusion: </strong>This study describes a local PJI microbiome with contrasting results from comparable studies. Empiric antibiotic guidelines have been established to target treatment and a local PJI register has since been established to improve patient outcomes and antimicrobial stewardship in an era of antibiotic resistance.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624809","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":"Impact of changes in gestational diabetes mellitus diagnostic criteria during the COVID-19 pandemic.","authors":"Jessica Neville, Kelly Foley, Seán Lacey, Antoinette Tuthill, Oratile Kgosidialwa, Mairead O'Riordan, Fiona O'Halloran, Seán J Costelloe","doi":"10.1007/s11845-025-03926-3","DOIUrl":"https://doi.org/10.1007/s11845-025-03926-3","url":null,"abstract":"<p><strong>Background/aims: </strong>During the COVID-19 pandemic, the Health Service Executive (HSE) and Royal College of Obstetricians and Gynaecologists (RCOG) recommended fasting and random plasma glucose (FPG/RPG) alongside glycated haemoglobin (HbA_1c) to replace the oral glucose tolerance test (OGTT) for diagnosing Gestational Diabetes Mellitus (GDM).</p><p><strong>Methods: </strong>The study compared testing patterns and diagnostic rates for GDM before and after implementing the RCOG guidelines (01/05/2020) in pregnancies beginning 01/11/2018 to 31/03/2021. Trends were inspected using Cochrane-Armitage tests. Differences between General Practice (GP) and Secondary Care (SCare) were assessed by chi-square analysis. A significance level of p < 0.05 was used for all analyses. Information on maternal and pregnancy characteristics was accessed where available.</p><p><strong>Results: </strong>Data indicated a significant reduction in OGTTs requested by GPs and SCare. Conversely, HbA_1c, FPG and RPG test requests increased significantly in both locations. The overall GDM positivity rate increased significantly from 7.4% to 22.0% in GP and 16.9% to 39.0% in SCare following RCOG guideline implementation.</p><p><strong>Conclusions: </strong>The RCOG guidelines appear to have been well adopted by GPs and SCare, with greater adherence in SCare. Using FPG, RPG and HbA_1c to a greater extent than the OGTT corresponded with increased GDM diagnostic rates. Given the difficulties with interpreting HbA_1c in pregnancy, its routine use in diagnosing GDM requires further careful consideration. Relaying changes in diagnostic protocol during pandemics requires strong communication with all requesting clinicians, including GPs. Comparisons between GP and SCare indicated significant differences in test-requesting practices and GDM positivity rates.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615595","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-7a microRNA modulates caspase-3-dependent apoptosis in melanoma cells treated with dabrafenib and trametinib combination.","authors":"Murat Keser, Harika Atmaca","doi":"10.1007/s11845-025-03923-6","DOIUrl":"https://doi.org/10.1007/s11845-025-03923-6","url":null,"abstract":"<p><strong>Background: </strong>Malignant melanoma is an aggressive tumor with high resistance to therapy. The emergence of RAS-driven secondary cancers and BRAF-inhibitor resistance has led to the development of combination therapies targeting both BRAF and MEK.</p><p><strong>Aims: </strong>This study explored the mechanisms underlying the synergistic effects of dabrafenib (DAB) and trametinib (TM) in drug-resistant A375 and RPMI 7951 melanoma cells.</p><p><strong>Methods: </strong>Cytotoxicity was assessed via MTT assay and combination effects were evaluated via combination index analysis. Apoptosis was analyzed by DNA fragmentation ELISA, while ectopic let-7a miRNA expression and inhibition were performed using lipofection. Gene expression levels were quantified by qRT-PCR, and protein expression was assessed via Western blot.</p><p><strong>Results: </strong>The combination of 0.7 μM DAB and 5.0 μM TM exhibited synergistic cytotoxicity by inhibiting the pERK1/2 signaling pathway and inducing MITF expression. This resulted in mitochondria-mediated apoptosis, characterized by a decrease in anti-apoptotic Bcl-2 and an increase in pro-apoptotic Bax, caspase-9, and caspase-3 levels. Additionally, Let-7a was identified as a crucial regulator of apoptosis sensitivity by targeting caspase-3, the key executor of apoptosis.</p><p><strong>Conclusions: </strong>These findings provide new insights into overcoming melanoma drug resistance through combined BRAF/MEK inhibition.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597084","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":"Comparative evaluation of microleakage of four restorative materials using confocal laser scanning microscopy: an in vitro study.","authors":"Annapoorna Kini, Kavana M G, Shubhashini N, Nithin Shetty, Venkata Suresh Venkataiah, Mohammad Fareed, Mohmed Isaqali Karobari","doi":"10.1007/s11845-025-03927-2","DOIUrl":"https://doi.org/10.1007/s11845-025-03927-2","url":null,"abstract":"<p><strong>Objective: </strong>Understanding the sealing ability of restorative materials to prevent microleakage and its consequent complications-such as secondary caries, postoperative sensitivity, and restoration failure-is imperative in clinical dentistry. This study aims to compare the microleakage performance of four restorative materials-bioactive composite resin (Activa Pronto), alkasite restorative (Cention N), compomer (Dyract Flow), and glass ionomer cement (Type 2 GIC)-in Class V cavities of extracted premolar teeth.</p><p><strong>Materials and methods: </strong>Forty non-carious, intact premolar teeth were selected and prepared with standardized Class V cavities. The teeth were randomly assigned to one of four groups (n = 10) and restored with the respective materials. The restorations underwent thermocycling, followed by microleakage testing using rhodamine dye. Confocal laser scanning microscopy (CLSM), a technique that provides superior depth resolution and three-dimensional visualization of microleakage, was used to assess dye penetration at the tooth-restoration interface. Microleakage was then scored using a standardized grading system.</p><p><strong>Results: </strong>Significant differences in microleakage were observed among the groups (χ² = 45.69; p < 0.001). Group 1 (bioactive composite resin) demonstrated the lowest microleakage, with predominantly Grade 0 and Grade 1 scores, while Group 4 (GIC) exhibited the highest microleakage, characterized mainly by Grade 3 scores. Bioactive composite resin exhibited significantly lower microleakage than alkasite, compomer, and GIC (p < 0.05). No significant difference was observed between alkasite and compomer.</p><p><strong>Conclusions: </strong>Bioactive composite resin (Activa Pronto) provided the most effective seal against microleakage, followed by alkasite and compomer, with glass ionomer cement showing the least effective sealing properties.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597081","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}