Rheumatology International最新文献

{"title":"Healthcare professionals' knowledge and perceptions of post-stroke rehabilitation in the peripandemic period: an online cross-sectional survey.","authors":"Meirgul I Assylbek, Olena Zimba, Marlen Yessirkepov, Burhan Fatih Kocyigit","doi":"10.1007/s00296-024-05746-7","DOIUrl":"10.1007/s00296-024-05746-7","url":null,"abstract":"<p><p>The COVID-19 pandemic has profoundly affected healthcare systems, particularly post-stroke rehabilitation centers. The elevated severity of strokes and delayed hospital admissions caused numerous hurdles to rehabilitation administration during the peri-pandemic period. This study surveyed healthcare professionals' knowledge and perceptions of post-stroke rehabilitation during this period. An online cross-sectional survey was administered from September 17, 2023 to February 23, 2024, utilizing the SurveyMonkey platform. The questionnaire included 30 questions addressing participant baseline characteristics, knowledge of definitions and experiences, post-stroke rehabilitation procedures, obstacles encountered during the peri-pandemic period, and the utilization of telerehabilitation. Only complete responses from health professionals were considered. This report utilized convenience sampling. Data were analyzed via descriptive statistics and chi-square tests, with a significance threshold of p < 0.05. A total of 79 health professionals, predominantly physiatrists, neurologists, and physiotherapists, from eight countries participated in the study. Over half of the participants (64.6%) indicated the existence of a dedicated department for post-stroke rehabilitation. Significant obstacles comprised an absence of advanced rehabilitative treatments (60.8%), inadequately skilled workers (50.6%), and restricted space for rehabilitation (46.8%). Telerehabilitation was regarded as a feasible option by 45.6% of participants; nonetheless, obstacles, including patients' telecommunication proficiency and the possibility of diagnostic inaccuracies, were acknowledged. Complementary therapies, such as music and dance therapy, received favorable evaluations from 67.1% to 63.3% of respondents, respectively. The pandemic reduced rehabilitation admissions due to infection concerns (75.9%) and increased multimorbidity cases among patients (48.1%). The study underscores the pandemic's negative effect on post-stroke rehabilitation, emphasizing the necessity for multidisciplinary, customized therapy and enhanced integration of telerehabilitation to overcome access barriers. Addressing obstacles regarding infrastructure, training, and access to advanced approaches, particularly in a post-pandemic context, is essential to improving rehabilitation outcomes.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":" ","pages":"3063-3071"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ovarian reserve alteration in premenopausal women with systemic sclerosis.","authors":"A C Pecher, J C Henes, A Demin, E M Staufenberg, M Henes","doi":"10.1007/s00296-024-05724-z","DOIUrl":"10.1007/s00296-024-05724-z","url":null,"abstract":"<p><p>Anti-Muellerian hormone (AMH) is produced by the granulosa cells of ovarian follicles. It serves as a sensitive laboratory parameter for assessing ovarian reserve. A reduced ovarian reserve has been observed in patients with various autoimmune diseases. To compare serum levels of AMH as a surrogate parameter for ovarian reserve in female patients with systemic sclerosis compared to healthy controls and thereby assess fertility. In this single centre study from the University Hospital Tuebingen, Germany, we used serum samples to determine concentrations of AMH via an electrochemiluminescence immunoassay. We analysed 30 premenopausal female patients with systemic sclerosis and 30 age-matched healthy controls from 18 to 40 years. Patients who had received cyclophosphamide were excluded from this study. AMH levels were significantly reduced in patients with systemic sclerosis (955 ng/l versus 1.940 ng/L, p < 0.01). Interestingly, in contrast to healthy controls, we observed no significant correlation between age and AMH levels in patients. For women diagnosed with systemic sclerosis, especially at a younger age, regular assessment of AMH levels should be considered to improve guidance with regard to optimal pregnancy timepoint, fertility preservation and treatment options.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":" ","pages":"3087-3092"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital ischemia: a rare immune-related adverse event of immune checkpoint inhibitors-case report and review of the literature.","authors":"Melina Yerolatsite, Nanteznta Torounidou, Aliki I Venetsanopoulou, George Zarkavelis, Davide Mauri, Paraskevi V Voulgari","doi":"10.1007/s00296-024-05709-y","DOIUrl":"10.1007/s00296-024-05709-y","url":null,"abstract":"<p><p>Immune checkpoint inhibitors (ICIs) play a crucial role in treating various cancers. While ICIs are invaluable in the fight against different cancers, they also pose the risk of immune-related adverse events (irAEs), which can range widely in symptoms and severity. Rheumatologic complications, including digital ischemia, are among the irAEs. While rare, they require early detection for effective management. The aim of the study is to present a case report on digital ischemia related to immunotherapy and to conduct a literature review on relevant cases. We present a case involving a patient from our oncology department who developed, pericarditis, digital ischemia and anti-centromere antibodies during immunotherapy with pembrolizumab for non-small cell lung cancer (NSCLC). We collaborated with our rheumatology department to initiate treatment, including corticosteroids, iloprost, and mycophenolate mofetil. Through the follow-up, the patient showed clinical improvement. A literature review identified only 10 relevant articles, highlighting the rarity of digital ischemia as an irAE. Corticosteroids and vasodilators were commonly used treatments, with amputation unavoidable in 40% of cases. IrAEs are becoming more common due to the widespread use of ICIs. For this reason, it is crucial to diagnose and treat rare IrAEs, such as digital ischemia, as early as possible to improve outcomes.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":" ","pages":"3141-3149"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney histopathology in predicting flares following drug withdrawal in proliferative lupus nephritis in clinical remission.","authors":"Aishwarya Gopal, Chengappa Kavadichanda, Mohan Sreelekha Gayathri, Mamatha Gorijavolu, Devender Bairwa, Christina Mary Mariaselvam, Bheemanathi Hanuman Srinivas, Molly Mary Thabah, Vir Singh Negi","doi":"10.1007/s00296-023-05497-x","DOIUrl":"10.1007/s00296-023-05497-x","url":null,"abstract":"<p><p>Residual renal histopathological activity at clinical remission in Proliferative Lupus Nephritis (PLN) can predict renal flare upon immunosuppression withdrawal. Data on the role of histological renal remission in predicting extra-renal flares is lacking. We assessed renal histopathology prior to drug withdrawal and the occurrence of renal and extra-renal flares over 52 weeks after drug withdrawal in PLN patients in long-term clinical remission. This is a subgroup analysis of a non-inferiority, open-label randomized (1:1) controlled trial. Patients with biopsy-proven Class III/IV LN in the past (biopsy 1), on immunosuppressants (IS) ≥ 3 years, in clinical remission for ≥ 1 year, on stable prednisolone dose (≤ 7.5 mg/day) plus a maintenance IS and hydroxychloroquine (HCQ) were subjected to a repeat renal biopsy (biopsy 2). Individuals with biopsy 2 having activity index (AI) < 4/24 were randomised to either prednisolone or IS withdrawal. Primary end-point was the proportion experiencing a flare [SELENA-SLEDAI flare index (SFI)] at week 52. Twenty-eight eligible patients underwent biopsy 2 and randomized to prednisolone (n = 15) and IS (n = 13) withdrawal. At biopsy 1, 12 (43%) had class III, 15 (53.5%) had class IV, and 1 (3.5%) had class III + V. At biopsy 2, PLN persisted in 4 (14.2%) while 18 (64.2%) were in histological remission (AI = 0) with 6 (21.4%) in class II. Following drug withdrawal, 9/28 (32%) had flares especially musculoskeletal (55.5%), mucocutaneous (44.4%), and renal (33.3%). Among the four persistent PLN patients, one of the two (50%) with AI = 1 had extra-renal flare while both the two with AI = 2 (100%) had renal and extra-renal flares. In those with histological remission (biopsy 2), 6/18 (66.6%) experienced extra-renal flare of whom one also had renal flare. Upon drug withdrawal, renal histopathology findings with any activity index can predict renal flare while histological remission is not enough to predict extra-renal flare, thus making it an unsuitable marker for deep SLE remission.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":" ","pages":"2885-2889"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138177188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-standing and poorly controlled disease in juvenile dermatomyositis is associated with calcinosis: a real-world experience from a low-middle income country.","authors":"Pankti Mehta, Able Lawrence, Latika Gupta, Durga P Misra, Vikas Agarwal, Ramnath Misra, Amita Aggarwal","doi":"10.1007/s00296-023-05377-4","DOIUrl":"10.1007/s00296-023-05377-4","url":null,"abstract":"<p><p>To study the prevalence and predictors of calcinosis in Juvenile Dermatomyositis (JDM). Medical records over 20 years at a tertiary care rheumatology center in Northern India were reviewed to identify patients with JDM and clinical details were recorded. The frequency of calcinosis, predictors, specific treatment, and its outcomes were studied. Data are expressed as median and interquartile range. In eighty-six patients (median age 10) of JDM, the frequency of calcinosis was 18.2% (8.5% at presentation). Younger age at presentation, longer follow-up, heliotrope rash [Odds Ratio (95% confidence interval), 11.4 (1.4-92.12)], chronic or polycyclic course [4.4 (1.2-15.5)] and cyclophosphamide use [8.2 (1.6-41.9)] were associated with calcinosis. Dysphagia [0.14 (0.02-1.2)] and elevated muscle enzymes [0.14 (0.04-0.5)] were negatively associated with calcinosis. Treatment with pamidronate had a good to moderate response to calcinosis in five of seven children. Calcinosis in JDM is associated with long-standing, poorly controlled disease, and the use of bisphosphonates like pamidronate offer promise in the future for its treatment.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":" ","pages":"3035-3040"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9808012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in rheumatology: perspectives and insights from a nationwide survey of U.S. rheumatology fellows.","authors":"Richa Purohit, Sathvik Saineni, Sweta Chalise, Reanne Mathai, Rajan Sambandam, Richard Medina-Perez, Neha Bhanusali","doi":"10.1007/s00296-024-05737-8","DOIUrl":"10.1007/s00296-024-05737-8","url":null,"abstract":"<p><p>Artificial Intelligence (AI) is poised to revolutionize healthcare by enhancing clinical practice, diagnostics, and patient care. Although AI offers potential benefits through data-driven insights and personalized treatments, challenges related to implementation, barriers, and ethical considerations necessitate further investigation. We conducted a cross-sectional survey using Qualtrics from October to December 2023 to evaluate U.S. rheumatology fellows' perspectives on AI in healthcare. The survey was disseminated via email to program directors, who forwarded it to their fellows. It included multiple-choice, Likert scale, and open-ended questions covering demographics, AI awareness, usage, and perceptions. Statistical analyses were performed using Spearman correlation and Chi-Square tests. The study received IRB approval and adhered to STROBE guidelines. The survey aimed to reach 528 U.S. rheumatology fellows. 95 fellows accessed the survey with response rate to each question varying between 85 and 95 participants. 57.6% were females, 66.3% aged 30-35, and 60.2% in their first fellowship year. There was a positive correlation between AI familiarity and confidence (Spearman's rho = 0.216, p = 0.044). Furthermore, 67.9% supported incorporating AI education into fellowship programs, with a significant relationship (p < 0.005) between AI confidence and support for AI education. Fellows recognized AI's benefits in reducing chart time (86.05%) and automating tasks (73.26%), but expressed concerns about charting errors (67.86%) and over-reliance (61.90%). Most (84.52%) disagreed with the notion of AI replacing them. Rheumatology fellows exhibit enthusiasm for AI integration yet have reservations about its implementation and ethical implications. Addressing these challenges through collaborative efforts can ensure responsible AI integration, prioritizing patient safety and ethical standards in rheumatology and beyond.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":" ","pages":"3053-3061"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients with systemic sclerosis frequently use phytopharmaceuticals: a cross-sectional survey.","authors":"Tuba Demirci Yildirim, Fatma Basibuyuk, A Merih Birlik","doi":"10.1007/s00296-024-05745-8","DOIUrl":"10.1007/s00296-024-05745-8","url":null,"abstract":"<p><p>The use of complementary and alternative medicine (CAM) has increased. Phytotherapy, also known as herbal medicine, is one of the CAM therapies that involves using medicinal plants and plant-derived substances. This study aims to evaluate the use of phytopharmaceuticals and the factors associated with their use in patients with Systemic sclerosis (SSc). Our study is designed as a survey and consists of two parts with 32 questions. The first part gathers demographic data with 14 questions, and the second part assesses participants' knowledge about phytotherapy with 18 questions. The questionnaire was administered face-to-face to patients with SSc who consented to participate. One hundred participants completed the survey. Fifty-two (52%) participants had diffuse sclerosis. Raynaud's phenomenon affected 97 (97%) participants; 53 (53%) participants suffered from lung involvement, and 64 (64%) had musculoskeletal system involvement. A total of 55 (55%) participants had used phytopharmaceuticals after SSc diagnosis. Phytotherapy users and non-users had similar demographic and clinical characteristics in terms of age, gender, disease duration, type of SSc, organ involvement, and education level. Participants mostly used the following phytopharmaceuticals: 23 participants used Camellia sinensis (green tea), 16 used Hypericum perforatum, and 12 used Curcuma longa (curcumin). The most improved symptoms with phytopharmaceuticals were musculoskeletal system findings and skin thickness, as stated by participants. A significant portion of SSc patients used phytopharmaceuticals in their disease duration. Although patients stated that they benefited from phytopharmaceuticals, studies on the effectiveness of these treatments are insufficient.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":" ","pages":"3079-3085"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biological therapy for psoriatic arthritis: current state and future perspectives.","authors":"Dominika Boboryko, Joanna Olejnik-Wojciechowska, Magdalena Baranowska, Aleksandra Wiktoria Bratborska, Patryk Skórka, Andrzej Pawlik","doi":"10.1007/s00296-024-05722-1","DOIUrl":"10.1007/s00296-024-05722-1","url":null,"abstract":"<p><p>Psoriatic arthritis is a medical condition that lies at the intersection of various fields of medicine, and its therapy always requires a comprehensive, holistic approach. Biological disease-modifying antirheumatic drugs (bDMARDs) constitute an extremely effective treatment method for PsA, provided that appropriate principles for patient qualification for the drug are followed, along with subsequent monitoring of the response to treatment. Based on their mechanisms of action, four main groups of bDMARDs used in PsA can be distinguished (TNF inhibitors, IL-12/23 and IL-23 inhibitors, IL-17 inhibitors, CTLA4 agonists). Clinical trials are ongoing in search of registration for additional bDMARDs, and the tasks for doctors and scientists worldwide include patient education, increasing treatment accessibility, and optimizing its costs.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":" ","pages":"2711-2725"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An integrated approach to the treatment of Rheumatic diseases: the role of psychological interventions.","authors":"Sholpan Bekarissova, Olzhas Bekarisov, Dana Bekaryssova","doi":"10.1007/s00296-024-05728-9","DOIUrl":"10.1007/s00296-024-05728-9","url":null,"abstract":"<p><p>Rheumatic diseases are chronic conditions that often result in significant physical and psychological challenges, reducing patients' quality of life and increasing the economic burden on healthcare systems. This study examines the vital role of psychological interventions in the comprehensive treatment of rheumatic diseases. The findings reveal a high prevalence of psycho-emotional disorders such as depression, anxiety, and stress among these patients, which can worsen disease progression and hinder treatment adherence. The review highlights the bidirectional relationship between the central nervous and immune systems, showing how psychological stress influences the pathophysiology of inflammatory diseases. Various psychological interventions are explored, including mind-body therapies, cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness-based practices such as meditation, yoga, and tai chi. These approaches improve emotional well-being, help reduce pain, and enhance overall quality of life. The article emphasizes a holistic treatment model incorporating pharmacological care, physical rehabilitation, and psychological support. This integrated approach fosters more effective management of rheumatic diseases by addressing their complex nature and promoting better functional outcomes. The study advocates for the seamless incorporation of psychological support into routine clinical practice tailored to the biopsychosocial profile of each patient. Future research should focus on identifying the most effective psychological interventions for different patient groups to enhance the quality of life for individuals with rheumatic diseases.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":" ","pages":"2727-2735"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treat-to-target vs fixed interval retreatment strategy with rituximab in rheumatoid arthritis: a retrospective cohort study.","authors":"Lisa Schapink, Nathan den Broeder, Alfons A den Broeder, Lise M Verhoef","doi":"10.1007/s00296-023-05524-x","DOIUrl":"10.1007/s00296-023-05524-x","url":null,"abstract":"<p><p>To compare the effectiveness of retreatment of rheumatoid arthritis (RA) patients with rituximab (RTX) following the treat-to-target retreatment (TTr) or fixed interval retreatment (FIr) strategy. RA patients starting RTX treatment between January 2008 and June 2016, and receiving at least three infusion cycles were grouped by strategy (TTr, FIr or both). Primary outcome (between strategy difference in DAS28-CRP (Disease Activity Score in 28 joints calculated with C-reactive protein)) and secondary outcomes (flares, use of co-medication and mean yearly dose of RTX) were analyzed by group using linear mixed models to account for different strategies within patients. A total of 213 patients, 59 TTr (of whom 32 switched from TTr to FIr) and 186 FIr were included. No between-group difference in mean DAS28-CRP was found (0.10 DAS28-CRP point (95% CI - 0.07 to 0.26)). The TTr strategy did not result in more flares (IRR 1.13, 95%CI 0.87 to 1.47), conventional synthetic disease-modifying antirheumatic drug use (difference - 11.7%, 95%CI - 26.3% to 2.9%), or lower mean yearly RTX dose (difference 172 mg/yr, 95%CI - 355 to 11.7 mg/yr). RTX retreatment with either a TTr or FIr strategy does not seem to lead to better disease control and/or less drug use when used in a DAS28-CRP treat-to-target context. Choice of either strategy can, therefore, be made based on patient and physician preferences and logistical context.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":" ","pages":"2921-2925"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139576721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}