Journal of Ayurveda and Integrative Medicine最新文献

{"title":"Cystic swelling and inflammation of MCL of knee joint managed with homeopathy; a case study with literature review and diagnostic pitfalls","authors":"Shuvasree Bhattacharya ,&nbsp;Pritam Goswami","doi":"10.1016/j.jaim.2025.101182","DOIUrl":"10.1016/j.jaim.2025.101182","url":null,"abstract":"<div><div>Knee pain is the most frequently encountered complaint in clinical practice among diverse age groups. In India, osteoarthritis alone covers 25–35 % of all rheumatological conditions. That stands out as one of the common causes of misdiagnosis of all other soft tissue and ligamentous diseases of the knee joint. However, in light of common clinical manifestations like osteoarthritis, many cases go neglected <em>and remains in the</em> grey area of literature. Here we are reporting a case of a 65-year-old female patient who presented with knee pain, and difficulty walking, and she was previously diagnosed with osteoarthritis. However, ultrasonography (USG) revealed a cystic enlargement measuring 12.3 × 5.4mm distal to the medial-cutaneous ligament (MCL) with inflammation and local edema. Following a thorough case evaluation, the patient was prescribed Ruta graveolens 200CH, followed by Thuja occidentalis 200CH. The anti-inflammatory, anti-tumor, and anti-cancer properties of both these medicines have been thoroughly demonstrated via many scientific experiments. We believe the positive effect is due to their alkaloids, but we have not questioned how they maintain their qualities at such high dilutions. The Lysholm Knee Score and Tegner Activity Scale (TLSS) were used to quantify progressive improvement. Significant improvement was observed with the following remission of cystic edema and local irritation. The TLSS climbed to 78 at the end of treatment from 56 at the beginning. Despite being a rare clinical presentation of knee pain, this case report is valuable in homeopathy since it is the first attempt to analyze knee joint functionality using TLSS.</div></div>","PeriodicalId":15150,"journal":{"name":"Journal of Ayurveda and Integrative Medicine","volume":"16 5","pages":"Article 101182"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healingwith integrative management of Diabetic foot ulcer - A case report","authors":"Rahul Katkar ,&nbsp;Aadithyaraj K.T. ,&nbsp;Usha Rana","doi":"10.1016/j.jaim.2025.101174","DOIUrl":"10.1016/j.jaim.2025.101174","url":null,"abstract":"<div><div>Diabetic foot ulcers (DFUs) occur in 15–25 % of diabetic patients at some point in their lifetime. The wide surgical debridement of the septic area is the cornerstone of diabetic foot ulcer treatment. There is a need to explore alternate therapies for DFU to reduce the risk of severe amputation. A 50-year-old male visited the Ayurveda OPD with a chronic ulcer on the plantar aspect of his right forefoot, which had persisted for two months. Ayurveda has considered <em>Dushta vrana</em> (∼septic nonhealing ulcer) and mentioned the <em>Vrana upkrama</em> (∼wound care measures) for its management. Among these <em>Vrana upkrama, Jalauka avcharana</em> (∼bloodletting using leech)<em>, Vrana Shodhana</em> (∼wound cleansing measures) by <em>Parisheka</em> (∼therapeutic streaming of medicated decoction)<em>, Vrana ropana</em> (∼wound-healing measures) are the three main wound care approaches along with <em>Shamana</em> (∼palliative therapy) for three months adopted in the present case for managing diabetic foot ulcers. DMIST tool was used to assess wound care at baseline and during follow-up. After three months of treatment, the integrated approach effectively shortens the healing time of DFUs, reduces the amputation rate and improves the standard of living of patients with DFUs with multiple Ayurvedic treatments.</div></div>","PeriodicalId":15150,"journal":{"name":"Journal of Ayurveda and Integrative Medicine","volume":"16 5","pages":"Article 101174"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and potential utility of integrated Yoga and Ayurveda (IYA) intervention for psychotropic-associated metabolic syndrome in patients with severe mental disorders: A prospective single-arm pre-post pilot study","authors":"Chandrasenan Santhosh ,&nbsp;Bhargav Hemant ,&nbsp;Varambally Shivarama ,&nbsp;Chikkanna Umesh ,&nbsp;Jasti Nishitha ,&nbsp;Suresh Meena Amritha ,&nbsp;Ramakrishna Kishore Kumar","doi":"10.1016/j.jaim.2025.101198","DOIUrl":"10.1016/j.jaim.2025.101198","url":null,"abstract":"<div><h3>Background</h3><div>Metabolic syndrome (MetS) is a major side-effect of antipsychotic and antidepressant medications that increases risk for cardiac and neurological disorders and hinders long-term adherence to treatment. Integrated Yoga and Ayurveda (IYA) intervention can potentially aid in counteracting these side effects.</div></div><div><h3>Objective</h3><div>To evaluate the efficacy and safety of Integrated Yoga and Ayurveda (IYA) intervention in psychotropic associated metabolic syndrome (MetS) in patients with severe mental disorders</div></div><div><h3>Materials and Methods</h3><div>A single-arm exploratory observational trial was conducted in an outpatient setting at a major tertiary mental healthcare hospital in South India<em>. The study included 29 consenting patients</em>(11 females and 18 males) with severe mental disorders (SMDs) stable on anti-psychotic and antidepressant medications diagnosed with MetS (NCEP-ATP III criteria). A 45-day IYA intervention comprising an Ayurveda herbal formulation (Triphala choorna 6 gm per dose) with warm water twice daily and a 10-min specific yoga program was administered. Assessments were performed at the baseline and after 45 days for the following variables: anthropometry, blood pressure, lipid profile, fasting blood sugar, and safety profile consisting of Renal Function and Liver Function tests. Seventeen patients completed the study. Data on <strong><em>changes in anthropometry and biochemical markers</em></strong> was analyzed using paired samples <em>t</em>-test.</div></div><div><h3>Results</h3><div><strong><em>A statistically significant reduction was observed in the following variables: body weight (p &lt; 0.001), BMI (p &lt; 0.001), Total cholesterol (p &lt; 0.05), and triglycerides (p &lt; 0.05).</em></strong> None of the patients reported any side effects of IYA. Clinical assessment at the end of 45 days did not reveal any worsening of psychotic symptoms.</div></div><div><h3>Conclusion</h3><div>IYA may serve as a safe and potentially effective adjuvant in addressing MetS in patients with SMDs who are on psychotropics.</div></div>","PeriodicalId":15150,"journal":{"name":"Journal of Ayurveda and Integrative Medicine","volume":"16 5","pages":"Article 101198"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative meta-analysis complementing systematic review evidence on yogic practices in hypertensive patients","authors":"G. Tarakeshwari ,&nbsp;Dapkupar Wankhar ,&nbsp;Deenadayalan Boopalan ,&nbsp;Maheshkumar Kuppusamy","doi":"10.1016/j.jaim.2025.101268","DOIUrl":"10.1016/j.jaim.2025.101268","url":null,"abstract":"","PeriodicalId":15150,"journal":{"name":"Journal of Ayurveda and Integrative Medicine","volume":"16 5","pages":"Article 101268"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An epistemological framework for advancing the integration of Ayurveda & modern medicine.","authors":"Payal P Wavhal","doi":"10.1016/j.jaim.2025.101179","DOIUrl":"10.1016/j.jaim.2025.101179","url":null,"abstract":"","PeriodicalId":15150,"journal":{"name":"Journal of Ayurveda and Integrative Medicine","volume":"16 5","pages":"101179"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomized controlled study protocol to determine the safety and efficacy of Sivanarvembu Kuzhithailam in the management of Psoriasis (Kalanjagapadai)","authors":"Rathinamala Rathinam ,&nbsp;Gayathri Gunalan ,&nbsp;Lavanya Alagusolaiyan ,&nbsp;Vinu Bharathi Balasubramaniam ,&nbsp;Rajendra Kumar Arumugam ,&nbsp;Sathiyarajeswaran Parameswaran","doi":"10.1016/j.jaim.2025.101191","DOIUrl":"10.1016/j.jaim.2025.101191","url":null,"abstract":"<div><h3>Background</h3><div>Psoriasis is a chronic skin disorder with a substantial global burden, affecting over 100 million people worldwide. Conventional treatments, including topical and systemic therapies, have their own limitations and side effects. Siddha medicine, deeply rooted with comprehensive principles, offers an alternative approach in Psoriasis management. This randomized controlled trial aims to explore the safety and efficacy of <em>Sivanarvembu Kuzhithailam</em>, a classical Siddha medicine in the management of Psoriasis.</div></div><div><h3>Objectives</h3><div>The primary objective of this RCT is to determine the safety and efficacy of Sivanarvembu Kuzhithailam (SVK) and Vetpalai thailam and to reduce the PASI score in Psoriasis patients significantly. The secondary objective involves validating the biochemical changes in the study participants and determining enhancements in their quality of life before and after treatment. As a result, specific inflammatory markers, proteins, antioxidants, and assessments of oxidative stress have been undertaken in this clinical trial to provide deeper insights into the extent of inflammation, disease severity, and the mechanisms of action of the trial drug.</div></div><div><h3>Methods</h3><div>This is a single center, open-label, parallel group, exploratory randomized controlled trial with a sample size of 90 and with the objective of determining the safety and efficacy of Sivanarvembu Kuzhithailam in the management of psoriasis. This study protocol followed the SPIRIT 2013 guidelines.</div></div><div><h3>Result</h3><div>The primary outcome is to measure the reduction in the Psoriasis Area and Severity Index (PASI) score from baseline to 91 days and safety parameters. Secondary outcomes include the evaluation of enhancements in participants' quality of life through the assessment of the Dermatology Life Quality Index, as well as the examination of antioxidant levels, inflammatory markers, biochemical markers, in blood samples of trial participants.</div></div><div><h3>Conclusion</h3><div>The outcome of the study can be extrapolated to the next level of clinical trials with larger populations to provide robust scientific evidence for this traditional Siddha formulation for global acceptance.</div></div>","PeriodicalId":15150,"journal":{"name":"Journal of Ayurveda and Integrative Medicine","volume":"16 5","pages":"Article 101191"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hashimoto's thyroiditis and hypothyroidism, treated with Shamana Chikitsa principles of Panduroga – A case report","authors":"P.K.V. Anand,&nbsp;Vaishali Deshpande","doi":"10.1016/j.jaim.2025.101172","DOIUrl":"10.1016/j.jaim.2025.101172","url":null,"abstract":"<div><div>Hypothyroidism as a sequel to Hashimoto's thyroiditis is a very common thyroid illness. The conventional treatment is replacement of thyroid hormone to compensate insufficient production from the gland. The clinical features manifested is of widely variable intensity and may not be proportionate always to the blood levels of hormones. The disease does not have a direct mention in Ayurvedic classics. In such instances, treatment principle is adopted from the principles of treatment mentioned for those diseases which holds a similarity in etiopathogenesis, based on the clinical presentations and Dosha-Dooshya analysis. Thus, treatment principles of various diseases such as Galagandam, Agnimandyam, Sthoulyam etc., are being used for the treatment of thyroid diseases. A case of hypothyroidism presented with clinical features similar to Pandurogam was managed with the medicines described in the context of Pandurogam and Sopham. Higher TSH levels were brought to normal limits and high anti thyroid peroxidase level was reduced with a set of Ayurvedic medicines for a longer duration. Keeping away from the popular translation of Pandurogam as Anemia, a symptom oriented diagnostic work up based exclusively on the Ayurvedic classics, followed by symptom-oriented selection of medicines suited to the diagnosis is effective in reducing both symptoms and blood values. This gives the hope of managing hypothyroidism with alternate treatment methods other than supplementation of hormone for lifelong.</div></div>","PeriodicalId":15150,"journal":{"name":"Journal of Ayurveda and Integrative Medicine","volume":"16 5","pages":"Article 101172"},"PeriodicalIF":1.9,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144916669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing clinical practice variability in Ayurveda: An urgent need for developing clinical practice guidelines","authors":"V. Ashwathykutty ,&nbsp;Unnikrishnan Payyappallimana ,&nbsp;V. Rakesh Narayanan","doi":"10.1016/j.jaim.2025.101201","DOIUrl":"10.1016/j.jaim.2025.101201","url":null,"abstract":"<div><div>Clinical practice guidelines (CPGs), which incorporate current evidence with the pondered judgment of experts, represent a promising approach to reducing unwarranted practice variation and promoting the application of research findings in clinical settings.</div><div>Globally, CPGs are developed by numerous local, national, and international organizations, and their production has significantly increased in the last two decades. In the realm of Traditional and Complementary Medicine (T&amp;CM), CPGs are gaining popularity, offering evidence-based recommendations for implementing T&amp;CM interventions in clinical practice.</div><div>While Korean medicine, Traditional Chinese medicine, and Kampo medicine have established robust CPGs guiding their healthcare practices and research in selected areas, the utilization of CPGs in any of the Ayush (term that represents the traditional and complementary systems of medicine, namely Ayurveda, Yoga &amp; Naturopathy, Unani, Siddha, Sowa Rigpa and Homoeopathy) systems of medicine remains largely unexplored. This paper advocates for investigating the feasibility of CPGs as a promising research program, outlining areas where they could be implemented and the benefits they could bring. It represents one of the initial studies exploring the potential of CPGs in Ayurveda.</div><div>The authors argue that it is crucial for stakeholders to provide the necessary momentum to develop robust and effective CPGs that integrate research with clinical practice to enhance patient care.</div></div>","PeriodicalId":15150,"journal":{"name":"Journal of Ayurveda and Integrative Medicine","volume":"16 5","pages":"Article 101201"},"PeriodicalIF":1.9,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144916670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterization and potential novel applications of zinc-based traditional medicine, Yashad Bhasma","authors":"Guruprasad C. Nille ,&nbsp;Monisha Bhuyan ,&nbsp;Laxmi Narayan Gupta ,&nbsp;Mohd Ali ,&nbsp;Chandra Shekhar Pati Tripathi ,&nbsp;Omkar S. Nille ,&nbsp;Shardendu Kumar Mishra ,&nbsp;Anuja Vibhute ,&nbsp;Pranoti Kamble ,&nbsp;Himanshu Ranjan ,&nbsp;Amaresh Kumar Singh ,&nbsp;Arpita P-Tiwari ,&nbsp;Anand Kumar Chaudhary","doi":"10.1016/j.jaim.2025.101188","DOIUrl":"10.1016/j.jaim.2025.101188","url":null,"abstract":"<div><h3>Background</h3><div><em>Yashad Bhasma</em> (YB), the incinerated metal ash of zinc, has been used for centuries in Ayurveda to address a variety of conditions, including eye diseases, diabetes mellitus, anemia, respiratory illnesses, etc.</div></div><div><h3>Objective</h3><div>This research aimed to synthesize and characterize YB and to evaluate its potential antimicrobial, antioxidant, and anti-angiogenic activities.</div></div><div><h3>Materials and methods</h3><div>In this study, YB is synthesized by optimizing the traditional method. Morphological and physicochemical characterization are performed using XRD, XPS, SEM, TEM, EDAX, DLS, TGA-DSC, and FTIR. The antimicrobial activity of YB is assessed using the well diffusion technique against the gram-positive bacterium <em>Staphylococcus aureus (S. aureus)</em> and the gram-negative bacterium <em>Escherichia coli</em> (<em>E. coli</em>). The antioxidant potential is evaluated using the 1,1-Diphenyl-2-Picrylhydrazyl (DPPH) radical scavenging assay and Nitric oxide (NO) radical scavenging assay. A chick chorioallantoic membrane (CAM) assay is performed on fertilized chick eggs to study the anti-angiogenesis potential of YB.</div></div><div><h3>Results</h3><div>The XRD patterns of YB showed the presence of cubic and hexagonal phases of ZnS having average crystallite size of 32.66 nm. XPS data supports the formation of ZnS phase of YB. SEM and TEM data confirmed the size of YB NPs in a range of 250–350 nm. The EDAX analysis confirmed the presence of Zn (37.2 %) and S (21.18 %). The mean particle diameter was 361 nm in DLS. TGA-DSC findings verified that the synthesized material is stable up to 435.80 °C. The FTIR confirms the presence of organic moieties in YB along with ZnS phase. YB effectively inhibited the growth of <em>S. aureus</em> and <em>E. coli</em>. The ability of YB to scavenge DPPH and NO radicals is found to be concentration dependent (50–250 μg/mL). The study also demonstrated that YB has notable antioxidant activity. The disappearance of blood vessels beneath the sample-loaded disk after 7 days indicated the effective anti-angiogenic properties of YB.</div></div><div><h3>Conclusion</h3><div>Altogether, YB exhibited significant antimicrobial, noteworthy antioxidant, and anti-angiogenic activities, indicating its potential as a promising therapeutic agent.</div></div>","PeriodicalId":15150,"journal":{"name":"Journal of Ayurveda and Integrative Medicine","volume":"16 5","pages":"Article 101188"},"PeriodicalIF":1.9,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144916668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete healing of a Dooshivishajanya non-healing wound with Jalaukavacharana - A case report","authors":"Praveen Balakrishnan,&nbsp;Emy S. Surendran,&nbsp;G.N. Sree Deepthi,&nbsp;A. Abhayadev,&nbsp;Lisha S. Raj","doi":"10.1016/j.jaim.2025.101187","DOIUrl":"10.1016/j.jaim.2025.101187","url":null,"abstract":"<div><div>A 35-year-old male patient, who is non-diabetic, non-dyslipidemic, normotensive, and euthyroid, and works as a hotel manager, visited our outpatient department with complaints of two ulcers on the inner side of his right lower leg, which developed rapidly after intense itching for about a week due to scratching. The ulcers were clean, had granulation tissue, caused mild pain, showed no discharge, and were surrounded by dark discolouration. The patient's history indicated that he had experienced severe itching in that area for four to five years, along with recurrent fevers, which began after being bitten by an unidentified type of black ant. The Bates Jensen wound assessment tool scored 33 for the larger wound and 27 for the smaller wound. Initially, the patient received some Ayurvedic treatments aimed at promoting healing for approximately 40 days, but these did not improve. A venous Doppler ultrasound of his right leg indicated chronic venous insufficiency. Given the persistent nature of the ulcers despite medical treatment, the condition was diagnosed as <em>Dooshi Vishajanya Vrana</em> over chronic venous insufficiency. Therefore, a single session of <em>Jalaukavacharana</em> was performed using three <em>Jalaukas</em> on the ulcer site, which healed within one week of the treatment. After the treatment, the Bates Jensen wound assessment scores improved to 18 for the larger wound and 17 for the smaller wound. Follow-up evaluations conducted after four months and one year revealed no recurrence of the ulcers. The dark discolouration of the leg began to diminish from the fourth month of the follow-up period.</div></div>","PeriodicalId":15150,"journal":{"name":"Journal of Ayurveda and Integrative Medicine","volume":"16 5","pages":"Article 101187"},"PeriodicalIF":1.9,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144916666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}