Irish Journal of Medical Science最新文献

{"title":"Role of shearing wave elastography in detecting early diabetic nephropathy.","authors":"Amr M Shaker, Shaza Y Sleem, Mayssa I Aly, Asmaa H Habib, Mona G Hassan","doi":"10.1007/s11845-025-03897-5","DOIUrl":"https://doi.org/10.1007/s11845-025-03897-5","url":null,"abstract":"<p><strong>Background: </strong>Diabetes mellitus is one of the systemic diseases affecting the kidneys that eventually develop end-stage kidney disease. Shear wave elastography (SWE) is a reliable and non-invasive ultrasonography test used to determine tissue elasticity. The aim of this study is to detect early diabetic nephropathy by measuring renal stiffness using shear wave elastography (SWE), renal resistivity indices, and laboratory findings in DN patients.</p><p><strong>Methods: </strong>Shear wave elastography and color duplex sonography assessments were performed in 60 diabetic nephropathy patients (divided according to eGFR into 3 stages: stage I-II-III diabetic nephropathy with equal groups of 20 patients in each stage) and 20 healthy age-matched control subjects. The SWE-derived mean value of the tissue stiffness, given in kilopascals (kPa), was correlated to patients' clinico-laboratory data (serum creatinine and eGFR) and resistive index.</p><p><strong>Results: </strong>There is a statistically significant increase in SWE and RI in the diabetic group than control group and a statistically significant increase in SWE (mean) in CKD stage II and III when compared with CKD stage I, SWE can be used to discriminate between diabetic groups and control group at a cutoff level of > 10.5 (kPa), and also, SWE (mean) can be used to discriminate between CKD stage II and III patients at a cutoff level of > 41 (kPa), with 66.7% sensitivity and 64.9% specificity.</p><p><strong>Conclusion: </strong>Shear wave elastography is a sensitive, non-invasive, and specific diagnostic tool for the detection of diabetic nephropathy and differentiation between different stages of DN.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255317","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":"Neurologists' perspectives of cannabis-based medicines: results from an all-Ireland survey.","authors":"Michael Savio, Hugh Kearney, Eric J Downer","doi":"10.1007/s11845-025-03880-0","DOIUrl":"https://doi.org/10.1007/s11845-025-03880-0","url":null,"abstract":"<p><strong>Background: </strong>Advancements continue to be made in the development of medicines containing components of the Cannabis sativa L. plant. Consultants can prescribe specific cannabis-based products for a restricted set of indications in Ireland, with neurologists being at the forefront of therapy. Much debate on the therapeutic potential/efficacy of such cannabis-based products exists.</p><p><strong>Aim: </strong>The objective of this study was to conduct a national survey to determine the perspectives/views of Irish neurologists regarding the use of cannabis-based medicines.</p><p><strong>Methods: </strong>An online anonymous survey was conducted to capture the perspectives and experiences of neurologists in Ireland regarding cannabis-based therapeutics.</p><p><strong>Results: </strong>Thirty-four neurologists completed the survey in full, with study participants rating their knowledge of cannabis-based medicines as average. Data presented herein indicate that there is a need for educational programmes on the cannabinoid system and cannabinoid-based medicines, and the findings indicate that neurologists are interested in the use of cannabinoid-based medicines in their practice. Study participants were more divided with regard to the clarity of the process for accessing cannabis-based medicines, and the consensus is that the application process is unclear. Approximately one-third of participants have made an application to access medicinal cannabis-based products on behalf of a patient.</p><p><strong>Conclusions: </strong>Data presented herein indicates that the majority of neurologists surveyed are aware of the current systems in place to access cannabis-based products for medicinal use in Ireland and that some engagement with these systems has taken place. A key finding is that educational programmes on the cannabinoid system and cannabis-based medicines are required.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079975","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":"Functional outcomes of inspiratory muscle training in elderly with intensive care unit-acquired weakness and severe walking disability.","authors":"Mushabbab Alahmari, Hany Farid Elsisi, Ali Mohamed Ali Ismail","doi":"10.1007/s11845-025-03876-w","DOIUrl":"https://doi.org/10.1007/s11845-025-03876-w","url":null,"abstract":"<p><strong>Background: </strong>Intensive care unit acquired-weakness syndrome (ICUAWS) leaves several complications in functional movements of patients such as severe walking disability.</p><p><strong>Objective: </strong>Assessment of functional outcomes of 1-month inspiratory muscle training (IMT) in elderly with ICUAWS and severe walking disability was our aim. The design, setting, participants, and intervention. This study is a randomized controlled trial. ICUAWS patients who complained of severe walking disability on the Modified Functional Ambulatory Category Test (MFACT) were randomly assigned into the IMT group or control group, n = 20 for each group. Both groups received the traditional physical therapy program.</p><p><strong>Results: </strong>The results showed that the post-therapy between-group comparison of ICUAWS sufferers/groups' parameters showed a significant improvement toward the IMT group in six-minute walk test, inspiratory and expiratory muscle strength, forced vital capacity, time up and go test, 10-m walk test, forced expiratory volume in the first second, 30-s sit-to-stand test, partial pressure of arterial blood oxygen and carbon dioxide, MFACT, oxygen saturation of arterial blood, physical, and mental summary of short form 36.</p><p><strong>Conclusion: </strong>In conclusion, IMT improves functional outcomes in ICUAWS patients with walking disability.</p><p><strong>Trial registration number: </strong>The clinical trial ID of this ICUAWS trial is NCT06210763.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079971","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":"Hepatotoxicity in spaceflight: intrinsic and extrinsic risks for astronaut metabolic health.","authors":"Ethan Waisberg, Joshua Ong, Mouayad Masalkhi, Ben Cools, Ryung Lee, Mathieu Vinken, Andrew G Lee","doi":"10.1007/s11845-025-03884-w","DOIUrl":"https://doi.org/10.1007/s11845-025-03884-w","url":null,"abstract":"","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079972","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":"Outpatient flexible cystoscopy in urogynaecology: a tertiary hospital's experience.","authors":"Parijot Kumar, Saboohi Tariq, Siji Philip, Caroline Hendricken, Fadi Salameh","doi":"10.1007/s11845-025-03891-x","DOIUrl":"https://doi.org/10.1007/s11845-025-03891-x","url":null,"abstract":"<p><strong>Objective: </strong>This study is a retrospective evaluation of a new outpatient flexible cystoscopy service in a tertiary care hospital in Dublin, Ireland.</p><p><strong>Design: </strong>This is a retrospective observational study.</p><p><strong>Setting: </strong>This study has been held at the Department of Gynaecology, Rotunda Hospital, Dublin.</p><p><strong>Population: </strong>This included all women who underwent outpatient flexible cystoscopy in Rotunda Hospital between May 2023 to October 2024.</p><p><strong>Materials and methods: </strong>Retrospective data collection included patient demographics, indications for referrals, cystoscopic findings, post-procedural complications, and cost-benefit analysis.</p><p><strong>Results: </strong>A total of 77 women underwent flexible cystoscopy. The mean age was 52.5 years ranging from 20 to 85 years. Flexible cystoscopy was successfully completed in all patients, and there were no post procedure complications. The most common indications were as follows: recurrent urinary tract infections (36%) and bladder pain syndrome (36%), followed by overactive bladder symptoms (14%). Fifty-five percent of patients had no abnormal findings. The most common abnormality found was trabeculations (39%), followed by glomerulations (9%). A cost-benefit analysis showed an approximate saving of € 1211 per patient leading to a saving of over € 93,000 over a period of 18 months.</p><p><strong>Conclusion: </strong>Outpatient cystoscopy is a low-risk, feasible, well tolerated, and safe diagnostic procedure, with no post-procedure complications observed in this study. It avoids the risks of general anaesthesia and is associated with lower procedural costs.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074758","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":"Prevalence of anti-nuclear antibodies in COVID-19 patients: a remarkable 2.5-fold rise compared to healthy controls.","authors":"Faruk Dişli, Sedat Yıldız","doi":"10.1007/s11845-025-03886-8","DOIUrl":"https://doi.org/10.1007/s11845-025-03886-8","url":null,"abstract":"<p><strong>Background: </strong>The SARS-CoV-2 virus, responsible for COVID-19, has the potential to induce the formation of antibodies that target self-antigens. This study aimed to investigate the prevalence of antinuclear antibodies (ANA), the most common type of autoantibody, in both healthy individuals and those recovered from COVID-19.</p><p><strong>Methods: </strong>This retrospective study involved 400 participants (200 with COVID-19 and 200 healthy controls), aged 18 to 60 years, without any chronic diseases, including autoimmune conditions. Analyses were performed using three different ANA ELISA test kits (anti-dsDNA, anti-ENA, and anti-Hep-2 nucleus tests) that were developed and validated.</p><p><strong>Results: </strong>Among the 200 healthy individuals, 38 (19%) tested positive for dsDNA, 37 (18.5%) for ENA, and 30 (15%) for Hep-2 nucleus antibodies. The rates of ANA positivity were significantly higher in individuals with COVID-19, with 97 (48.5%) positive for dsDNA, 81 (40.5%) for ENA, and 84 (42%) for Hep-2 nucleus antibodies (p < 0.05).</p><p><strong>Conclusion: </strong>One in every two to three individuals with COVID-19 exhibited ANA positivity, indicating that the SARS-CoV-2 virus poses a significant risk regarding autoimmunity. Furthermore, the incidence of ANA in healthy individuals was observed to be higher than the literature average.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074760","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":"Knowledge and attitude to dietary regimen among patients with type 2 diabetes mellitus: implication for glycemic control.","authors":"Mary Isioma Ofili, Ugochukwu E Uzuegbu, Bartholomew Chukwuebuka Nwogueze, Clinton Ulakpa","doi":"10.1007/s11845-025-03871-1","DOIUrl":"https://doi.org/10.1007/s11845-025-03871-1","url":null,"abstract":"<p><strong>Objective: </strong>Diabetic patients frequently face difficulty in identifying and adhering to dietary regimen, including its quality and quantity. This study assessed the knowledge and attitude to dietary regimen among patients with type 2 diabetes mellitus in Delta State University Teaching Hospital, Oghara, as implication for glycemic control. The objectives of the study were to evaluate the knowledge on dietary regimen, assess the attitude to dietary regimen among diabetic patients, and determine the relationship between the knowledge and attitude to dietary regimen among diabetic patients.</p><p><strong>Methods: </strong>Descriptive survey design was used for the study. Convenience sampling technique and a sample size of 150 were used. Self-developed questionnaire was administered. Data was collected, analyzed, and presented in tables.</p><p><strong>Results: </strong>Findings from the study shows that 80% of the respondents have knowledge on adherence to dietary regimen while 61.3% of the respondents finds keeping to dietary regimen for managing diabetes difficult. Meanwhile, highest responses were attributed to family support, this was followed by support group and enlightenment programs, while the least measure was found in mass campaign.</p><p><strong>Conclusions: </strong>It therefore shows that although there is high knowledge base on dietary regimen, diabetic patients often find difficulty in adhering to the prescribed regimen. Hence, it is important that measures to promote positive attitude to dietary regimen among diabetic patients be devised to enhance management outcomes.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074739","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":"Self-perceived knowledge, influencing factors and proposed educational interventions for diagnostic stewardship in the microbiology laboratory: The experience of Irish paediatric doctors.","authors":"Rachel Barry, Colm O Tuathaigh, Robert Cunney","doi":"10.1007/s11845-025-03872-0","DOIUrl":"https://doi.org/10.1007/s11845-025-03872-0","url":null,"abstract":"<p><strong>Background: </strong>Lab users should display an understanding of microbiology tests and avoid inappropriate requests which may yield negative clinical consequences. Our research addressed diagnostic stewardship education and the perspectives of paediatric hospital doctors on their (1) self-perceived knowledge, (2) motivators for test ordering, (3) proposed educational interventions and (4) preferred teaching modalities.</p><p><strong>Methods: </strong>An anonymous, mixed-methods, 34-item online questionnaire was distributed to paediatric doctors across three Irish hospital sites from March to May 2023. Descriptive statistics summarised Likert-scale responses and inductive thematic analysis was used to analyse open-ended items. Subgroup analyses examined differences between consultants and non-consultant hospital doctors (NCHDs).</p><p><strong>Results: </strong>The analysis included 100 respondents (n = 45 consultants, n = 55 NCHDs, 24% response rate). Consultants scored higher than NCHDs in self-perceived knowledge (p < 0.001). Patient comorbidity, clinical status, local guidelines and accuracy of microbiological tests were the strongest motivators for test-ordering. Consultants were more likely to be influenced by accuracy (p = 0.03), costs (p = 0.01) and laboratory workload (p = 0.01). Only 27% reported formal teaching on diagnostic stewardship. NCHDs demonstrated increased willingness to engage in educational interventions (p = 0.024), and a comparatively higher interest in in-person teaching (p = 0.002) and gamification (p = 0.02). Respondents indicated a preference for formal guidelines on microbiology testing, in-person teaching, cost familiarisation and e-learning modules. Novel methods (peer-to-peer programmes, simulation and gamification) were less favoured. Dominant themes included; collaborative learning, increased microbiology presence, accessibility to education, barriers and administrative issues.</p><p><strong>Conclusion: </strong>Formal diagnostic stewardship educational programmes should be integrated into post-graduate curriculums for both NCHDs and consultants. Focuses for educational interventions include; development of local diagnostic stewardship guidelines, teaching on the cost and accuracy of microbiology tests, senior supervision and role-modelling.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065549","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":"From preparation to success: assessing the effectiveness of Saudi Pharmacists Licensure Examination (SPLE) preparation strategies in Saudi Arabia.","authors":"Dalia Almaghaslah","doi":"10.1007/s11845-025-03892-w","DOIUrl":"https://doi.org/10.1007/s11845-025-03892-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;This study aimed to identify the most commonly used tools by recent pharmacy graduates who successfully passed the Saudi Pharmacists Licensure Examination (SPLE). It also sought to evaluate which tools were perceived as the most useful and representative of the exam content, while considering their monetary value and offering recommendations for future candidates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional design was used, involving licensed pharmacists who graduated in 2019 or later and had successfully passed the SPLE. Data were collected using a questionnaire adapted from a previous study, which examined the most frequently utilized tools for SPLE preparation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The most frequently used preparation tools included SPLE question banks created by pharmacists who had previously passed the exam, which were shared predominantly through Telegram channels and utilized by 89.1% of respondents. Creator-led SPLE preparation tools with social media engagement were used by 89.6% of participants, while 40.1% relied on books. Less commonly used tools included YouTube channels (27.8%) and website-based SPLE preparation resources available via CME platforms (4.12%). The tools rated as most useful were creator-led SPLE preparation tools with social media engagement (average score: 4.22/5) and question banks (average score: 4.2/5). These tools were also deemed the most representative of the SPLE content, scoring an average of 3.9/5 and 4.09/5, respectively. This research highlights the critical role of specialized preparation strategies in equipping pharmacy graduates for success in the Saudi Pharmacists Licensure Examination (SPLE). Among the tools evaluated, question banks and creator-led preparation courses, particularly those leveraging social media platforms, emerged as the most valued resources. These tools were not only widely utilized but also praised for their alignment with the actual exam content and the mentorship opportunities they provide, fostering confidence and readiness among candidates. The findings also point to a noticeable decline in the popularity of college-led courses and other traditional platforms. This trend suggests a growing preference for flexible, self-directed learning approaches that are tailored to meet the specific demands of the SPLE. Such approaches allow candidates to adapt their study schedules and focus on high-yield content, aligning with their individual preparation needs. In conclusion, the results underscore the importance of accessible, practical, and exam-focused preparation resources in improving SPLE outcomes. Future efforts should consider integrating the strengths of these tools into institutional support systems, potentially bridging the gap between formal education and licensure readiness. Further studies are recommended to explore the cost-effectiveness and long-term impact of these tools on professional development and practice readiness among pha","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057993","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":"Kidney function estimation equations: a narrative review.","authors":"Nisha Abdul Khader, Veena Ganesh Kamath, Shobha Ullas Kamath, Indu Ramachandra Rao, Attur Ravindra Prabhu","doi":"10.1007/s11845-025-03874-y","DOIUrl":"https://doi.org/10.1007/s11845-025-03874-y","url":null,"abstract":"<p><p>Glomerular filtration rate (GFR) as a marker of kidney function is important in health and disease management because decreased kidney function is associated with all-cause and cardiovascular mortality, progression of kidney disease, predisposition to acute kidney injury (AKI), and for drug dosage modification. While measured glomerular filtration rate (mGFR) is acknowledged as the most accurate method for evaluating kidney function, it is at present not feasible to be applied in the clinical arena. Estimated glomerular filtration rate (eGFR) is preferred due to its convenience, cost-effectiveness, and seamless integration into standard clinical practice for kidney function evaluation. The presence of multiple equations for eGFR with applications to differing populations makes their use challenging for clinicians. We reviewed available estimated glomerular filtration rate (GFR) equations and their application in different clinical settings both in normal and chronic kidney disease (CKD) patients. These formulae incorporate serum creatinine and/or serum cystatin C levels and correlate them with measured kidney function. Among the many available equations, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is the most recommended due to its robustness and accuracy across diverse patient populations. Strengths and limitations of different eGFR equations are discussed emphasizing the importance of selecting the appropriate equation based on specific patient demographics and clinical scenarios. There is need for regional validation studies to ensure the global applicability of these equations, considering the variations in population characteristics.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052591","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}