I. I. Kutsenko, I. O. Borovikov, M. V. Galustyan, A. S. Magay, O. I. Borovikova
{"title":"Possibilities of predicting purulent-inflammatory complications after cesarean section","authors":"I. I. Kutsenko, I. O. Borovikov, M. V. Galustyan, A. S. Magay, O. I. Borovikova","doi":"10.21886/2219-8075-2022-13-4-73-87","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-4-73-87","url":null,"abstract":"Objective: identify the main risk factors in the development of purulent-inflammatory complications after cesarean section. Materials and methods: puerperal women after cesarean section (n = 90): 24 patients with a complication of puerperia in the form of endometritis (group I), 16 — with the insolvency of the suture on the uterus (group II) and 50 — with a physiologically occurring postoperative period (group (III) of control). An analysis of anamnestic, clinical and laboratory studies of puerperal women after abdominal delivery with a complicated postoperative period was carried out. With the help of logistic regression with the construction of an ROC-curve, a rank correlation analysis of the influence of adverse factors with the calculation of diagnostic coefficients (DC) was performed. Results: based on the assessment of the identified main clinical-anamnestic and laboratory predictors, using mathematical modeling methods, a scale for predicting the risk of purulent-inflammatory complications in early puerperia after abdominal delivery has been developed. Conclusion: prognostic mathematical scale for assessing the risk of purulent-inflammatory complications in puerperal women after abdominal delivery makes it possible to identify the main predictors of infectious diseases in these patients, which contributes to their timely prevention and, thereby, reducing the frequency of severe forms of postpartum infection.","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86289387","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}
T. A. Bazieva, I. M. Ordiyants, B. A. Dzhabrailova, R. U. Тunguzbieva
{"title":"Modern ideas about endometrial disorders with habitual miscarriage","authors":"T. A. Bazieva, I. M. Ordiyants, B. A. Dzhabrailova, R. U. Тunguzbieva","doi":"10.21886/2219-8075-2022-13-4-53-57","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-4-53-57","url":null,"abstract":"The cause of 75% of all implantation failures is impaired endometrial receptivity. Most of the implantation window markers studied are regulated by estradiol and progestrone. Steroid hormones are involved in the binding of molecular makers to specific nuclear receptors and any disturbance in steroid receptor expression can lead to impaired endometrial morphofunctional properties and receptivity. There are three levels of receptivity: genetic, proteomic, and morphological. According to genetic studies, during the implantation window period, there is a 10-fold increase in the expression of about 395 genes in parallel with a decrease in the expression of other 186 genes, various proteases, cell adhesion molecules and matrix proteins. Proteomic markers that affect endometrial receptivity include various growth factors, cytokines, cell adhesion molecules, and integrins. One of the main markers of the morphological level of receptivity is the pinopodia. Over the past 20 years, a large number of molecular markers of endometrial receptivity have been studied and the understanding of implantation mechanisms has expanded. But, despite this, no ideal marker for the assessment of endometrial receptivity in impaired fertility has been found. For the most accurate and effective diagnosis and to reduce the incidence of early reproductive loss, it is necessary to investigate all three levels of endometrial receptivity.","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76321277","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":"Hypoxic-ischemic brain damage of the fetus and newborn with hemodynamic disorders in the “mother-placenta-fetus” system","authors":"S. Berezhanskaya, M. К. Abduragimova","doi":"10.21886/2219-8075-2022-13-4-88-99","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-4-88-99","url":null,"abstract":"Objective: to identify the dependence of the severity of cerebral disorders in newborns and children of the first year of life on the indicators of blood flow in the utero-placental complex. Materials and methods: a total of 184 full-term newborns were examined in the period from birth to one year of life. The main group included children with cerebral ischemia of II and III severity and its consequences (group II, n=78; group III, n=42). Group I included newborns without signs of central nervous system damage, 14 of them had neurological symptoms by the end of the neonatal period (after a month, group I n =50, group II n =92). All children underwent general clinical examination, assessment of neurological status, ultrasound examination of the brain, transcranial dopplerography of cerebral vessels, electroencephalography. Maternal medical records were analyzed to identify hemodynamic parameters in the \"mother-placenta-fetus\" system at 12-13, 20-21, 28-32, and 36-40 weeks of gestation. Results: The features of uterine and fetal blood flow in the dynamics of gestation in mothers of the examined groups of children were determined. The associations between the values of Pi AUD, AUS, and AUM in the second and third trimesters of pregnancy in different groups were shown. The relationship between disorders of uteroplacental hemodynamics and the severity of cerebral pathology was revealed. A \"method of antenatal prediction of the severity of cerebral disorders in newborns\" was proposed. Conclusions: The obtained results make it possible to predict the risk of hypoxic-ischemic damage to the central nervous system in newborns antenatally using hemodynamic parameters in the mother-placenta-fetus system at 36 weeks of gestation.","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83060393","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}
A. Kononenko, N. Pichurina, S. Vodyanitskaya, F. V. Logvin, V. V. Batashev, N. G. Tyutyunkova, E. G. Soboleva
{"title":"The experience of introducing new technologies for training medical workers in the educational process in the conditions of the COVID-19 pandemic","authors":"A. Kononenko, N. Pichurina, S. Vodyanitskaya, F. V. Logvin, V. V. Batashev, N. G. Tyutyunkova, E. G. Soboleva","doi":"10.21886/2219-8075-2022-13-4-122-126","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-4-122-126","url":null,"abstract":"In the context of the pandemic of the new coronavirus infection COVID-19 (hereinafter, COVID-19), the priority activity of medical organizations was the organization of training of medical workers on epidemiology and prevention of COVID-19, which required the development of a new architecture of the educational process. In order to improve the knowledge of medical staff, new educational technologies were used, which made it possible to cover a wide range of medical workers in a short time and to improve their level of qualification in epidemiology and prevention of COVID-19. Purpose. To summarize the experience of using remote content to improve the skills of medical professionals in epidemiology, prevention and biosafety when working with COVID-19 patients using modern training forms and methods. Materials and methods. A program of seminars for medical workers was developed, which included sections of epidemiology, prevention of COVID-19, and rules of compliance with the anti-epidemic regime when working with COVID-19 patients. The training of medical workers was carried out using modern IT technologies. Discussion. New technologies made it possible to expand the training opportunities for medical workers. To increase the level of knowledge and exchange of experience, it became possible to invite highly qualified specialists for tutoring. Conclusion. The use of modern forms of education makes it possible to expand significantly the possibilities of the educational process, make available the necessary information about the epidemiology and prevention of COVID-19 to a wide range of health workers, and increase the effectiveness of the training. The role of a teacher with the introduction of such technologies acquires a new quality, called a tutor.","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75781520","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}
I. Marinkin, L. Shpagina, E. S. Lisova, I. Shpagin, O. Kotova, G. Kuznetsova, E. Loktin, S. Karmanovskaya
{"title":"Endometrial hyperplasia features in conditions of organic solvents exposure","authors":"I. Marinkin, L. Shpagina, E. S. Lisova, I. Shpagin, O. Kotova, G. Kuznetsova, E. Loktin, S. Karmanovskaya","doi":"10.21886/2219-8075-2022-13-4-28-38","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-4-28-38","url":null,"abstract":"Objective: to establish clinical and molecular features of endometrial hyperplasia in conditions of organic solvents exposure in patients with obesity. Materials and methods: postmenopausal women with endometrial hyperplasia (morphological criteria) were included to observational cross-sectional study. The main group included 140 subjects with occupational organic solvents exposure, aged 57,5 (46;64) years, of whom 70 had obesity and 70 had normal weight. Comparison group — 140 women without of occupational health risks, aged 56,5 (46;65) years, 68 with and 72 without obesity. Investigated workers were painters in machine building industry with length of service above 10 years, in post-contact period lasted for 1-5 years were 29 (20.7%) of participants. Organic solvents concentrations at the workplace’s areas were 1.5-5.5 times above occupational exposure limits. Linear and logistic regression were used to explore relationships. Level of significance p<0.05. Results: workers exposed to organic solvents had maximal percent of atypical endometrial hyperplasia: 34.3% in obesity subjects and 18.6% in those without obesity, in the comparison group 10.3% in subjects with and 6.9% in those without obesity, p=0.004. Subgroup with toxicant exposure with obesity characterized by maximal expression of Ki-67 (55,9±2,51, 51,4±4,95, 41,5±3,29 and 30,1±2,18 scores respectively), higher rate of uterine bleeding, M-echo thickness, blood interleukin 1β concentration. Atypical endometrial hyperplasia was associated with length of service (OR 1.80), maximal short-term exposure concentration of toluene (OR 2.51), waist circumference (OR 1.68), Ki-67 (OR 2,01), estrogen receptors on epithelium (OR 1.92). Conclusions: organic solvents exposure in postmenopausal women with endometrial hyperplasia contributes to development of atypical hyperplasia, systemic inflammation, Ki-67 expression, higher grades in subjects with obesity.","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"53 6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83405933","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}
F. M. Yakupova, R. Garipova, F. S. Gilmullina, J. M. Sozinova, M. M. Zagidov
{"title":"Viral hepatitis B and C as occupational diseases","authors":"F. M. Yakupova, R. Garipova, F. S. Gilmullina, J. M. Sozinova, M. M. Zagidov","doi":"10.21886/2219-8075-2022-13-4-39-44","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-4-39-44","url":null,"abstract":"Objective: to study the clinical and epidemiological features and medical and social aspects of viral hepatitis B and C in medical workers. Materials and methods: analysis of outpatient and inpatient records of medical workers with a diagnosis of chronic viral hepatitis B, C, B + C, B + D of various stages and degrees of activity, registered at the Republican Center of Occupational Pathology of the Republic of Tatarstan and the consultative and diagnostic department of the Republican Infectious Clinical Hospital named after prof. A.F. Agafonov. An on-line sociological survey of medical workers and senior students of medical universities in Kazan was conducted using the Google form. Results: medical personnel whose work is associated with the provision of invasive medical interventions are at the highest risk of infection with blood-borne infections. All medical workers had a history of accidents - needle sticks, cuts, blood spatter. The development of liver cirrhosis and the presence of lethal outcomes in liver cirrhosis decompensation reflect the general problem of chronic hepatitis C - the lack of timely effective antiviral therapy, despite the detection of hepatitis viruses in medical workers in the early stages of infection during periodic medical examinations. Conclusions: in the structure of occupational morbidity among healthcare workers in Tatarstan, viral hepatitis makes up 16.7%. There is still a risk of viral hepatitis infection in MRs of any level of education and status, including students of medical universities during work practice, assistance on a volunteer basis. Vaccination/revaccination against viral hepatitis B is regulated by regulations and shown to all healthcare workers with viral hepatitis C.","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"113 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86023726","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}
O. Skvortsova, N. Migacheva, E. Mikhaylova, L. I. Katkova
{"title":"Assessment of the prevalence of overweight and obesity among school-age children in Samara","authors":"O. Skvortsova, N. Migacheva, E. Mikhaylova, L. I. Katkova","doi":"10.21886/2219-8075-2022-13-4-106-113","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-4-106-113","url":null,"abstract":"Purpose: Assessment of the prevalence of overweight and obesity among school-age children in Samara. Material and methods. Medical checkup of 1503 schoolchildren aged from 7 to 14 years old was performed. The authors assessed anthropometric indicators, calculated body mass index, and standard deviation score. Diagnosis of overweight or obesity was based on the analysis of the indicators according to the criteria of the World Health Organization. Results. The prevalence of overweight among schoolchildren in Samara made up 20.9% and obesity was observed in 13.5%. The prevalence of obesity among boys was significantly higher than in girls (63.58% vs 39.48%, respectively). The peak debut of obesity occurs at an early school age. In the study group, obesity of 1st degree was most common (67.2% of obese children). A comparison of the obtained data with previous studies revealed that the prevalence of obesity increased dramatically over the past fifteen years (from 3.6% to 13.5%). The prevalence of overweight has also increased from 10.6% to 20.9%. Conclusion. Considering the increasing prevalence of overweight and obesity among school-age children, this problem should remain one of the priorities for the Samara region.","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"68 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75247515","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}
D. Vinnikov, Z. Tulekov, L. Strizhakov, S. A. Babanov, N. E. Lavrentyeva
{"title":"Spirometry and respiratory disease risk factors in firefighters in Almaty","authors":"D. Vinnikov, Z. Tulekov, L. Strizhakov, S. A. Babanov, N. E. Lavrentyeva","doi":"10.21886/2219-8075-2022-13-4-14-21","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-4-14-21","url":null,"abstract":"Objective: to ascertain respiratory symptoms, lung function and selected respiratory disease risk factors in firefighters of the city of Almaty. Materials and methods: N=1379, 91% males, firefighters working in Almaty were recruited at the annual screening, where CAT (COPD Assessment Test) and mMRC (Modified Medical Research Council) questionnaires were offered to quantify the severity of respiratory symptoms. We also assessed respiratory risk factors, including cigarette smoking, exposure to environmental tobacco smoke, fossil fuel use for heating and cooking, and regular physical activity, followed by spirometry. Vital capacity (VC), forced VC (FVC) and forced expiratory volume in one second (FEV1) were measured. Results: Median age was 28 (interquartile range (IQR) 25-35) years, years in service median 5 (IQR 3-13) years. 41% of employees were daily cigarette smokers (significantly more among males, 43 vs. 16%), whereas 93% were exposed to environmental tobacco smoke and only 57% were engaged in regular leisure physical activity. With the overall low score of respiratory symptoms, the prevalence of postbronchodilator FEV1/FVC reduction below lower limit of normality in males was 2%, whereas the diagnosis of chronic bronchitis in the past was found in 2% of participants. Conclusions: healthy worker effect in firefighters of Almaty can explain very low prevalence of bronchoobstructive syndrome among those enrolled in this analysis, even despite high smoking prevalence.","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89210254","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}
M. R. Kantsurova, A. N. Rymashevsky, N. Sapronova, M. Babaev, R. S. Sapronov
{"title":"Evaluation of treatment results in patients after surgical hemostasis using CT-angiography","authors":"M. R. Kantsurova, A. N. Rymashevsky, N. Sapronova, M. Babaev, R. S. Sapronov","doi":"10.21886/2219-8075-2022-13-4-66-72","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-4-66-72","url":null,"abstract":"Objective: to evaluate the results of treatment of patients after undergoing surgical hemostasis in obstetric hypotonic bleeding. Materials and methods: the 31 patients were examined, whose delivery was complicated by hypotonic uterine bleeding, and as a result, surgical hemostasis was performed in the amount of ligation of the ovarian and internal iliac artery. Anthropometric data were analyzed, as well as the dynamics of the results of laboratory and instrumental research methods before and after surgery. In the late postoperative period, the results of helical computed tomography (CT) under angiography conditions were evaluated in the period from 6 months to 5 years. Statistical processing was carried out using the IBM SPSS Statistics 25 program. Results: the age, anamnestic data, anatomical and physiological parameters of patients, terms of delivery and their outcome did not become predictors of developed hypotonic bleeding. Early postpartum bleeding was determined in 93,5% of cases. Extirpation of the uterus was performed in 9,7% of cases. The median blood loss was 1200,0 ml, blood loss of 45-50% of the BCC was determined in 19,4%, 35–45% of the BCC was also in 19,4%. The reduced level of erythrocytes persisted until the moment of discharge, and the reduced hemoglobin after the operation tended to increase. In the course of CT, in 100% of cases, defects in the contrasting of the internal iliac artery on both sides were determined. Collateral circulation was also developed in 100,0% of cases, despite the type of defect in the internal iliac artery. Conclusions: ligation of the ovarian and internal iliac artery is a reliable method of surgical hemostasis, which allows saving the uterus in 90,3% of cases. In the late postoperative period, all patients developed various degrees of arterial patency in the ligation zone, and collateral circulation developed on both sides.","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88263087","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":"Features of the course of ankylosing spondylitis depending on the psychosocial status and duration of the disease","authors":"I. Blaginina","doi":"10.21886/2219-8075-2022-13-4-114-121","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-4-114-121","url":null,"abstract":"Purpose: to study the influence of psychosocial indicators and duration of the disease on the quality of life (QL), anxiety-depressive spectrum disorders (ADSD) and clinical and laboratory activity in patients with ankylosing spondylitis (AS). Materials and methods: the study involved 112 patients with AS. The author assessed clinical and laboratory activity of the disease, QOL (SF-36), the presence of ADSD (using the Taylor, Hamilton, and Spielberger scales), and autonomic disorders depending on the duration of the disease and the level of education. Results: in most patients with AS, signs of ADSD were detected, while in persons with higher education (HE), ADSD were significantly more common, and they had a higher level of anxiety and depression. Patients with HE have lower vital activity, the ability to adapt to social functioning, and an indicator of mental health. The study of the effect of AS duration on QL allowed the author to establish an association between an increase in AS duration and a decrease in the indicator of the psychological component of health. Conclusions: male patients with a higher level of education, who are characterized by lower indicators of QOL, mainly psychological health, have a greater tendency to develop ADSD. An increase in the duration of AS disease does not affect the development of ADSD. With the duration of AS for over 10 years, the indicators of the psycho-emotional and physical components of QOL decrease. There is a tendency in the increase in anxiety and depression levels, antioxidant protection factors are getting exhausted, inflammatory activity progresses, and personal perception of pain intensifies.","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"87 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82073550","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}