Clinical Parkinsonism Related Disorders最新文献

{"title":"The effects of Baduanjin on fine motor skills in mild and moderate Parkinson’s disease: A randomized controlled trial","authors":"Ke-Fan Li ,&nbsp;Jun Li ,&nbsp;A-Long Xia ,&nbsp;Xiao-Wei Wang ,&nbsp;Ai-Ling Wang ,&nbsp;Ying Shi ,&nbsp;Huai-Zhen Chen","doi":"10.1016/j.prdoa.2024.100276","DOIUrl":"10.1016/j.prdoa.2024.100276","url":null,"abstract":"<div><h3>Background</h3><div>Fine motor impairment is common in Parkinson’s disease (PD), which reduces patients’ quality of life. There are few suitable targeted treatments. We conducted a clinical trial to determine whether Baduanjin Qigong exercise would increase fine motor skills in PD patients.</div></div><div><h3>Methods</h3><div>Sixty PD patients (Hoehn-Yahr stage 1–4) with hand fine motor impairment were randomly assigned to the Baduanjin group and the physical activity group. Baduanjin group practiced Baduanjin exercise five times weekly for 40 min (warm-up 5 min, Baduanjin 30 min, cool-down 5 min). The usual physical activity groups maintained their habit of usual physical activities. The participants underwent assessments in the “ON” medication state at baseline and 4-week follow-up time points. The Purdue Pegboard Test (PPT) was used as the primary outcome to assess manual dexterity. The secondary outcomes included the Movement Disorders Society-Unified Parkinson’s Disease Rating Scale, part III (MDS-UPDRS III), and the Parkinson’s disease questionnaire (PDQ-39).</div></div><div><h3>Results</h3><div>The results of PPT revealed the Baduanjin group showed statistically significant improvement in the “non-dominant hand” and “assembly” scores compared to the usual physical activity group (P &lt; 0.05), but with no significant difference in “dominant hand” and “both hands” (P &gt; 0.05). Additionally, the Baduanjin group showed better performance in the PDQ-39 (P &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Our study concludes that a 4-week Baduanjin exercise is effective in improving fine motor function and quality of life in patients with mild and moderate PD. The results suggest a promising intervention to be implemented in community or home settings for managing fine motor impairment in PD.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"11 ","pages":"Article 100276"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142532119","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":"Acceptability of and attitudes to the therapeutic use of cannabis and cannabidiol in people with Parkinson’s disease: A French survey","authors":"Tangui Barré ,&nbsp;Géraldine Cazorla ,&nbsp;Vincent Di Beo ,&nbsp;Fabienne Lopez ,&nbsp;Lise Radoszycki ,&nbsp;Gwenaëlle Maradan ,&nbsp;Christelle Baunez ,&nbsp;Patrizia Carrieri","doi":"10.1016/j.prdoa.2024.100286","DOIUrl":"10.1016/j.prdoa.2024.100286","url":null,"abstract":"<div><h3>Introduction</h3><div>Cannabis and cannabidiol (CBD) may potentially alleviate symptoms and improve the quality of life of people with Parkinson’s disease (PD), although clinical results to date have provided conflicting evidence. In France, cannabis use is illegal outside the current restricted medical cannabis experimental framework which does not include PD as an eligible condition. In contrast, CBD products are legal and are easily available. We aimed to evaluate the acceptability of therapeutic cannabis and CBD use, and to assess cannabinoid-related attitudes among people with PD in France, with a view to assessing the potential inclusion of medical cannabinoids in PD treatment options.</div></div><div><h3>Methods</h3><div>We conducted a French nationwide online survey among people with PD. Cannabis and CBD acceptability levels were derived from the answers to four questions. Logistic regressions were performed to identify factors associated with these levels. We also collected data on knowledge, information-seeking, and barriers to self-medication.</div></div><div><h3>Results</h3><div>Of 1136 participants, acceptability levels of medical cannabis and CBD use were 81.7% and 87.4%, respectively. For both substances, acceptability was associated with the presence of anxiety symptoms, greater knowledge about cannabinoids, seeking information on medical cannabis, and considering the risk of cannabis dependence to be low. A fear of dependence was one of the main barriers to using either substance; healthcare providers were rarely mentioned as sources of information on medical cannabis.</div></div><div><h3>Conclusions</h3><div>Acceptability levels of cannabis and CBD were high. Acceptability was associated with knowledge and perceptions of cannabinoids. Given ongoing misconceptions about the effects and risks associated with CBD, disseminating accurate information could increase its acceptability in people with PD.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"11 ","pages":"Article 100286"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757561","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":"Two distinct degenerative types of nigrostriatal dopaminergic neuron in the early stage of parkinsonian disorders","authors":"Tomoya Kawazoe ,&nbsp;Keizo Sugaya ,&nbsp;Yasuhiro Nakata ,&nbsp;Masato Okitsu ,&nbsp;Kazushi Takahashi","doi":"10.1016/j.prdoa.2024.100242","DOIUrl":"https://doi.org/10.1016/j.prdoa.2024.100242","url":null,"abstract":"<div><h3>Introduction</h3><p>The present study characterized the degeneration of nigrostriatal dopaminergic neurons in the early stages of parkinsonian disorders using integrative neuroimaging analysis with neuromelanin-sensitive MRI and ¹²³I-FP-CIT dopamine transporter (DAT) SPECT.</p></div><div><h3>Methods</h3><p>Thirty-one, 30, and 29 patients with progressive supranuclear palsy (PSP), corticobasal syndrome (CBS) with abnormal specific binding ratio (SBR) in either hemisphere (mean ± 2SD), and parkinsonism-predominant multiple system atrophy (MSA-P), respectively, were enrolled. Neuromelanin-related contrast (NRC) in the substantia nigra (NRC_SN) and locus coeruleus (NRC_LC) and the SBR of DAT SPECT were measured. All the patients underwent both examinations simultaneously within five years after symptom onset. After adjusting for interhemispheric asymmetry on neuromelanin-related MRI contrast using the Z-score, linear regression analysis of the NRC_SN and SBR was performed for the most- and least-affected hemispheres, as defined by the interhemispheric differences per variable (SBR, NRC_SN, standardized [SBR + NRC_SN]) in each patient.</p></div><div><h3>Results</h3><p>Although the variables did not differ significantly between PSP and CBS, a significant correlation was found for CBS in the most-affected hemisphere for all the definitions, including the clinically defined, most-affected hemisphere. No significant correlation was found between the NRC_SN and SBR for any of the definitions in either PSP or MSA-P.</p></div><div><h3>Conclusion</h3><p>Together with the findings of our previous study of dementia with Lewy bodies (DLB) and Parkinson’s disease (PD), the present findings indicated that neural degeneration in the disorders examined may be categorized by the significance of the NRC_SN-SBR correlation in PD and CBS and its non-significance in DLB, PSP, and MSA-P.</p></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"10 ","pages":"Article 100242"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590112524000112/pdfft?md5=d89ae4696309caa5d2726c1b349f3aa3&pid=1-s2.0-S2590112524000112-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139748811","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":"Changes in neurologists’ treatment preferences for Parkinson’s disease in the Netherlands","authors":"Constant V.M. Verschuur,&nbsp;Sven R. Suwijn,&nbsp;Rob M.A. de Bie","doi":"10.1016/j.prdoa.2024.100241","DOIUrl":"https://doi.org/10.1016/j.prdoa.2024.100241","url":null,"abstract":"","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"10 ","pages":"Article 100241"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590112524000100/pdfft?md5=1b7f827fc6a5844274e78dcd78055bf4&pid=1-s2.0-S2590112524000100-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139748812","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":"Micrographia after midbrain infarction alleviated by Japanese calligraphy-style writing: A case report","authors":"Kazutaka Sakamoto ,&nbsp;Kyungshil Kim ,&nbsp;Ryota Kobayashi ,&nbsp;Kayoko Yokoi ,&nbsp;Daichi Morioka ,&nbsp;Shinobu Kawakatsu ,&nbsp;Akihito Suzuki ,&nbsp;Kazumi Hirayama","doi":"10.1016/j.prdoa.2024.100257","DOIUrl":"https://doi.org/10.1016/j.prdoa.2024.100257","url":null,"abstract":"","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"10 ","pages":"Article 100257"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590112524000288/pdfft?md5=295faf277feba7e29dad4c9fbbd2e268&pid=1-s2.0-S2590112524000288-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140914062","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":"Botulinum toxin therapy in Parkinson disease-related lower limb dystonia. An 8 year retrospective review","authors":"Antonia Schonwald ,&nbsp;Katherine Amodeo ,&nbsp;Victoria Levy ,&nbsp;Fabio Danisi","doi":"10.1016/j.prdoa.2024.100260","DOIUrl":"https://doi.org/10.1016/j.prdoa.2024.100260","url":null,"abstract":"<div><h3>Background</h3><p>Lower extremity dystonia (LED) is a frequent complication of Parkinson disease (PD). Treatment with botulinum neurotoxinA (BoNTA) over 8 years was retrospectively reviewed.</p><p>Cases</p><p>14 patients with LED received an average of 3.86 injections (1–8). Mean interval was 40 weeks (median of 25). Average dose was 182 units. Injections were well-tolerated. Using a 6 point scale, there was an average of 3.37 point improvement in disability after each session, with average duration of 28.56 weeks (median 11 weeks). After mean follow-up of 101 weeks, disabling dystonia was not present in 11 of 14 patients.</p></div><div><h3>Conclusions</h3><p>Botulinum toxin is safe and effective in PD related LED. Good response to the first two injection sessions was significantly associated with greater likelihood of long-term response. Assertive BoNTA dosing may lead to sustained remission of symptoms. As natural history of LED in PD has not been reported, prospective placebo-controlled studies are needed.</p></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"11 ","pages":"Article 100260"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590112524000318/pdfft?md5=6048d78b1cb0a01adf92551e36356c7e&pid=1-s2.0-S2590112524000318-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141313064","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":"Exploring bradyphrenia in Huntington’s disease using the computerized test of information processing (CTiP)","authors":"Georgia M. Parkin ,&nbsp;Braden Culbert ,&nbsp;Emma Churchill ,&nbsp;Paul E. Gilbert ,&nbsp;Jody Corey-Bloom","doi":"10.1016/j.prdoa.2024.100243","DOIUrl":"https://doi.org/10.1016/j.prdoa.2024.100243","url":null,"abstract":"<div><h3>Background</h3><p>Bradyphrenia, best thought of as the mental equivalent of bradykinesia, has been described in several disorders of the brain including Parkinson’s disease and schizophrenia; however, little is known about this phenomenon in Huntington’s Disease (HD).</p></div><div><h3>Objective</h3><p>The aim of this study was to investigate the presence of bradyphrenia in HD using the Computerized Test of Information Processing (CTiP), an easy to administer and objective task that assesses cognitive processing speed with increasing task complexity.</p></div><div><h3>Methods</h3><p>This study included 211 participants: Huntington’s Disease Integrated Staging System (HD-ISS) Stage 0 [n = 28], Stage 1 [n = 30], Stage 2 [n = 48] and Stage 3 [n = 48], and healthy controls (HC) [n = 57]. The CTiP incorporates three subtests: Simple Reaction Time (SRT), which assesses baseline motor function; Choice Reaction Time (CRT), with an added decisional component; and Semantic Search Reaction Time (SSRT), with an added conceptual component. SRT scores were subtracted from CRT and SSRT scores to establish a motor-corrected measure of central conduction time, which was used to operationalize bradyphrenia.</p></div><div><h3>Results</h3><p>HD-ISS and HC within-group reaction times differed significantly when comparing motor-corrected CRT vs SSRT (all <em>p</em>s &lt; 0.0001). Furthermore, the magnitude of these differences increased with HD disease stage (p &lt; 0.0001). An ROC analysis determined that motor-corrected within-subject differences significantly distinguished Stage 2 + 3 from Stage 0 + 1 (AUC = 0.72, p &lt; 0.0001).</p></div><div><h3>Conclusions</h3><p>We report evidence of bradyphrenia in HD that increases with disease progression. This processing deficit, which can be quantified using the CTiP, has the potential to greatly impact HD daily life and warrants additional research.</p></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"10 ","pages":"Article 100243"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590112524000124/pdfft?md5=84939ed7d20e689dd9ec03f5693e9f13&pid=1-s2.0-S2590112524000124-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139935537","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":"Zinc gluconate for Wilson disease","authors":"Mark S. LeDoux","doi":"10.1016/j.prdoa.2024.100272","DOIUrl":"10.1016/j.prdoa.2024.100272","url":null,"abstract":"<div><div>Due to financial constraints, a patient with Wilson disease required transitioning his maintenance pharmacotherapy from zinc acetate to zinc gluconate. Herein, we report the clinical and laboratory outcomes of this switch and review the relevant literature on the treatment of Wilson disease with zinc. Zinc gluconate can be a viable treatment option for patients with Wilson disease and may be associated with fewer gastrointestinal side effects than zinc acetate and, accordingly, improved long-term compliance and improved clinical outcomes.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"11 ","pages":"Article 100272"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142424906","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":"The effect of tactile cueing on dual task performance in Parkinson’s disease. A systematic review and meta-analysis","authors":"Viktoria Azoidou ,&nbsp;Alastair J Noyce ,&nbsp;Cristina Simonet","doi":"10.1016/j.prdoa.2024.100284","DOIUrl":"10.1016/j.prdoa.2024.100284","url":null,"abstract":"<div><h3>Background</h3><div>Dual-task (DT) performance is impaired in Parkinson’s disease (PD), contributing to bradykinesia, postural instability, freezing of gait, and falls. Tactile cueing, including vibrotactile stimulation, has been suggested to improve DT performance in PD.</div></div><div><h3>Research Question</h3><div>Does tactile cueing affect DT performance in PD, specifically measured by dual-task cost (DTC)?</div></div><div><h3>Methods</h3><div>A systematic review was conducted in PubMed and EMBASE up to October 30, 2023, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were those in English that examined the effects of tactile cueing and/or closed-loop vibrotactile stimulation on DT performance in adults over 18 with idiopathic PD. The primary outcome, DTC, was calculated as the percentage change in performance from DT to single-task using the formula: [(single-task − dual-task)/single-task]* 100. A <em>meta</em>-analysis using a random-effects model pooled standardized mean differences (SMD) of DTC. Statistical significance was set at p &lt; 0.05.</div></div><div><h3>Results</h3><div>From 130 initially identified studies, eight were included in the review. Four studies with 374 participants were included in <em>meta</em>-analyses focusing on walking speed and step length. Three of the four studies indicated that tactile cueing improved DTC for these parameters. However, the SMD for walking speed (−109.69; 95 % CI −454.89 to 235.51, p = 0.39) and step length (−14.21; 95 %CI −53.25 to 24.83, p = 0.33) showed weak evidence of improvement.</div></div><div><h3>Conclusion</h3><div>The <em>meta</em>-analysis provides weak evidence that tactile cueing may enhance walking speed and step length in DT conditions in PD. Rigorous objective studies are still lacking in this field of research.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"11 ","pages":"Article 100284"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706426","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":"Determinants of care partner burden in atypical Parkinsonian syndromes: A retrospective, multi-center analysis","authors":"Jessica Shurer ,&nbsp;Margaret Ivancic ,&nbsp;Vanessa Nesspor ,&nbsp;Maria Schmidt ,&nbsp;Mingyuan Li ,&nbsp;Yi-Ting Lin ,&nbsp;Grant Schumock ,&nbsp;Richard Xu ,&nbsp;Miriam Sklerov ,&nbsp;Alexander Pantelyat","doi":"10.1016/j.prdoa.2024.100266","DOIUrl":"10.1016/j.prdoa.2024.100266","url":null,"abstract":"<div><h3>Introduction</h3><p>Progressive supranuclear palsy (PSP), corticobasal syndrome (CBS), and multiple system atrophy (MSA) are rare neurodegenerative diseases associated with rapid decline and require complex symptom management. Caregiving responsibilities significantly increase with progression of these atypical Parkinsonian syndromes, yet care burden in these syndromes has not been researched extensively to date.</p></div><div><h3>Methods</h3><p>The Zarit Burden Interview (ZBI) was used to assess burden in care partners of patients clinically diagnosed with PSP, CBS, or MSA seen in specialty interdisciplinary clinics at two academic movement disorders centers. Univariable and multivariable regression analyses were performed to evaluate cross-sectional demographic and clinical determinants of care partner burden.</p></div><div><h3>Results</h3><p>A total of 139 care partners completed the ZBI (59.0% PSP, 28.1% MSA, 12.9% CBS). Cohorts at both medical centers were similar across all variables. Female gender of both patients and care partners was independently associated with higher ZBI scores. Additionally, MSA-Parkinsonian type was significantly associated with lower total care partner burden compared to PSP and CBS.</p></div><div><h3>Conclusion</h3><p>Several determinants of higher care partner burden in atypical Parkinsonian syndromes were identified, particularly female gender and diagnosis. Healthcare professionals can consider this information when assessing individualized needs of patients and care partners and referring to disease-specific resources. Additionally, this study’s methods and results highlight the potential to further explore interdisciplinary care as a means of comprehensive evaluation and support for those with atypical Parkinsonism.</p></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"11 ","pages":"Article 100266"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590112524000379/pdfft?md5=b631fffe9201d99e6cffb5c3cbd272b5&pid=1-s2.0-S2590112524000379-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141736411","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}