Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii最新文献

{"title":"COVID-19 in Patients with Primary Biliary Cholangitis","authors":"М. К. Prashnova, K. Raikhelson, N. V. Marchenko, S. Zakharenko","doi":"10.22416/1382-4376-2022-32-3-29-34","DOIUrl":"https://doi.org/10.22416/1382-4376-2022-32-3-29-34","url":null,"abstract":"The aim of the study. To analyze the course of COVID-19 infection in patients with primary biliary cholangitis (PBC).Materials and methods. In a single-center retrospective study, survey and analysis of medical records of 144 patients with PBC was carried out.Results. All patients (n = 144) received basic therapy with ursodeoxycholic acid (UDCA), 5 of them received fibrates as well. Response to therapy (EASL criteria) was obtained in 30 people. Between March 2020 and March 2021, 50 patients (34.7 %) suffered COVID-19, with mean age of 58.8 ± 10.7 years, 16 of which were diagnosed with liver cirrhosis. Mild COVID-19 was observed in 34 (68 %) people, moderate course — in 14 (28 %), severe — in 2 (4 %), cases of extremely severe course were not recorded. 12 patients were hospitalized, 8 of which received oxygen therapy due to a decrease in SpO2 < 94 %, there was no need for the use of other methods of oxygen therapy in any case. The duration of hospitalization was 11.4 ± 5.7 days. There was a higher initial activity of serum alkaline phosphatase (1.8 ± 1.0 versus 1.7 ± 1.4 times of the upper limit of normal, M ± SD, p = 0.04) in patients with COVID-19 infection and lack of UDCA therapy effectiveness was more prominent (40 % vs. 19.1 % of cases, p = 0.04) compared with patients who did not have COVID-19. There were no significant differences in characteristics of the course of PBC (stage, response to therapy) and age in correlation with severity of the course of COVID-19. Among hospitalized patients and those in need of oxygen support, large proportion were older patients (58.3 % and 62.5 %, respectively) and patients with concomitant diseases (62.5 % and 75 %, respectively). Patients who hadn`t previously responded to UDCA therapy were more likely to require oxygen support compared to patients responding to basic therapy (p < 0.01).Conclusion. PBC is not a risk factor for severe COVID-19. A protective effect of UDCA in SARS-CoV-2 infection is possible, which requires further investigation.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85721461","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":"Technologically-Treated Polyclonal Affinity-Purified Antibodies to the Tumor Necrosis Factor-α, Brain Specific S-100 Protein and Histamine in Treatment of Functional Dyspepsia: Results of the Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial","authors":"Y. Shulpekova, I. Maev, V. Grinevich, I. Khlynov, Y. Shvarts, V. Ivashkin","doi":"10.22416/1382-4376-2022-32-3-40-51","DOIUrl":"https://doi.org/10.22416/1382-4376-2022-32-3-40-51","url":null,"abstract":"The aim of the study was to evaluate the efficacy and safety of Kolofort® (a complex medicine containing technologically processed forms of antibodies to S-100 protein, tumor necrosis factor-α and histamine) in the management of functional dyspepsia (FD) in outpatient clinical practice.Methods: Outpatients (N = 309) at the age of 18–45 in whom FD was diagnosed according to the Rome IV criteria were enrolled in a multicenter, double-blind, placebo-controlled, randomized clinical trial. Patients were randomized in two groups receiving Kolofort® or placebo 2 tablets tid for 8 weeks. The primary endpoint of the study was a change in the FD symptoms severity score according to the Gastrointestinal symptom score (GIS) at week 8. ITT and [PP] analysis were performed.Results: at week 8 the reduction in GIS sum score was observed in Kolofort® group and placebo group (by 7.2 ± 3.3 [7.2 ± 3.4] and 6.3 ± 4.6 [6.2 ± 4.5], respectively, p = 0.041 [0.039]). The proportion of cases with GIS score reduction by ≥4 was 88,1 % [88.6 %] and 79.1 % [79.6 %] in Kolofort® group and placebo group, respectively (p = 0.046 [p = 0.051]). None of the patients in Kolofort® group had progression of FD symptoms or required additional therapy. There were 29 adverse events (AEs) recorded in 25 patients including 16 cases in 13 (8.6 %) patients in Kolofort® group and 13 AEs in 12 (7.6 %) patients in placebo group.Conclusion: the clinical trial demonstrates the positive effect of Kolofort® in FD with a favorable safety profile. ","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"151 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85614291","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":"The Association of High COVID-19 Cases and Mortality with Anomalous High Surface Ozone Concentration in Moscow City in Summer 2021","authors":"E. Stepanov, V. Andreev, D. Chuprov, V. Ivashkin","doi":"10.22416/1382-4376-2022-32-3-18-22","DOIUrl":"https://doi.org/10.22416/1382-4376-2022-32-3-18-22","url":null,"abstract":"Aim: to compare statistical data on the frequency of COVID-19 and deaths from it with the ozone content in the surface atmosphere of Moscow in the summer of 2021.Materials and methods. We used data on the frequency of daily COVID-19 cases and mortality from COVID-19 in Moscow in 2020–2021 published by Rospotrebnadzor. Data on the ozone content in the surface layer of the atmosphere were obtained by an automatic monitoring station using a chemiluminescent analyzer.Results. The waves of high frequency of COVID-19 cases and mortality from COVID-19 in Moscow in the summer of 2021 were compared with abnormally high concentrations of ozone in the surface atmosphere of the megalopolis. Variations of these parameters were found to be markedly correlated. The coefficients of correlation of the COVID-19 cases and mortality with the concentration of ground-level ozone were 0,59 (p < 0.01) and 0.60 (p < 0.01), respectively.Conclusion. The observed noticeable relationship may be due to the combined pathological effect of high concentrations of ozone and the SARS-CoV-2 on the respiratory and circulatory organs, which can lead to both easier transmission of infection and a more severe course of the disease with increased mortality.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87246133","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":"Modern Approaches to Vaccination of Patients with Chronic Liver Diseases and Inflammatory Bowel Diseases against a Novel Coronavirus Infection","authors":"A. Sheptulin, V. Ivashkin","doi":"10.22416/1382-4376-2022-32-3-7-11","DOIUrl":"https://doi.org/10.22416/1382-4376-2022-32-3-7-11","url":null,"abstract":"Aim. To analyze the literature data on the peculiarities of vaccination of patients with chronic liver diseases (CLD) and inflammatory bowel diseases (IBD) against COVID-19 infection.Key findings. It has been shown that many patients with CLD (cirrhosis of the liver, non-alcoholic fatty liver disease) have a higher risk of severe course of a novel coronavirus infection, which necessitates their vaccination. IBD patients are also subject to vaccination, although the immunomodulatory drugs which they take may reduce its effectiveness. In addition, the correct timing of the vaccine administration is of great importance. Vaccination of patients with CLD and IBD is safe, and the frequency of side effects during its implementation does not differ from that in the general population.Conclusion. Analysis of literature data shows that patients with CLD and IBD are subject to vaccination against COVID-19 infection, which is effective and safe. ","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82828039","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":"Vaccination and Mortality of Patients with a Novel Coronavirus Infection (COVID-19): A Global Approach","authors":"N. Benuni, A. Kotusov, F. S. Adzhieva, A. Kucher, K. A. Tolmacheva, V. N. Dushuk, R. Maslennikov","doi":"10.22416/1382-4376-2022-32-3-23-28","DOIUrl":"https://doi.org/10.22416/1382-4376-2022-32-3-23-28","url":null,"abstract":"Aim. The aim is to study the correlation between the vaccination rate (VR) and mortality rate of patients with COVID-19 (MpCOV).Methods. The countries with gross domestic product per capita corrected for purchasing power parity (GDP PPP) over $-10,000 were selected for an ecologic study. The city-states and countries with a population of 1,000,000 were excluded. The number of patients who died from COVID-19 within a week was divided by the number of patients diagnosed with COVID-19 within a week 20 days earlier to calculate MpCOV.Results. We included 85 countries. VR (r = –0.604; p < 0.001) and GDPpcPPP level (p = 0.202), is an independent determinant of MpCOV. There was no significant difference in MpCOV between groups of countries with VR < 20 % and 20–39 % (1.96 [1.21; 4.67] vs. 1.96 [1.01; 3.36] %; p = 0.464). MpCOV was higher in countries where VR were lower when groups of countries with VR of 20–39 %, 40–59 %, 60–79 %, and ≥80 % were compared (1.96 [1.01; 3.36] vs. 1.11 [0.76; 1.64] vs. 0.50 [0.39; 1.00] vs. 0.16 [0.10; 0.21]; p = 0.003; p = 0.020, and p = 0.008).Conclusions. An increase in VR correlates with a decrease in MpCOV.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80886139","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 Medical Care Providing to Patients with Digestive Diseases in the Krasnodar Region during the COVID-19 Pandemic","authors":"N. Korochanskaya, V. M. Durleshter, S. A. Gabriel’, O. V. Kovalevskaya, S. N. Serikova, M. A. Basenko","doi":"10.22416/1382-4376-2022-32-3-12-17","DOIUrl":"https://doi.org/10.22416/1382-4376-2022-32-3-12-17","url":null,"abstract":"The aim of the study: optimization the medical care provision to patients with diseases of the digestive system (DD) in the Krasnodar Region during the COVID-19 pandemic.Material and methods. The analysis of the features of the DD course in the Krasnodar Region was carried out according to the data of form C 51 “Distribution of the dead by sex, age groups and causes of death” of the Territorial Federal State Statistics Service in the Krasnodar Region, as well as monitoring the quality of medical care for patients with DD for the period from 2019 to 2021 years.Results. During the COVID-19 pandemic, the routing of gastroenterological patients, dispensary observation and preventive measures have undergone some changes. In the structure of total mortality in the Krasnodar Region, mortality from DD was 21.6 % in 2020 and 4.0 % in 2021. The decrease in the growth of mortality rate, including from DD, in the second year of the pandemic is associated with the completed healthcare systems reformatting. The increase in hospital mortality in patients with gastric and duodenal ulcers, ulcerative colitis, and diverticular disease had a significant impact on mortality rates from DD. The decreasing number of hospitalizations was explained due to the conversion of a number of hospitals into hospitals for the treatment of patients with COVID-19. The hospitalization was mainly carried out for emergency indications and patients with a more severe course of the disease. The pandemic has increased the need for telemedicine: 378 tele-consultations on the gastroenterological profile was carried out in the Krasnodar Region in 2021.Conclusion. Healthcare system workload in the Krasnodar Region increased significantly during the coronavirus pandemic that required a number of structural adjustments. In recent times, the regional health care is returning to the planned mode of providing medical care. ","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"2012 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86428122","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":"Prevalence of Small Intestinal Bacterial Overgrowth Syndrome in Patients with Irritable Bowel Syndrome who Have Suffered COVID-19","authors":"A. V. Nalyotov, N. P. Guz","doi":"10.22416/1382-4376-2022-32-3-35-39","DOIUrl":"https://doi.org/10.22416/1382-4376-2022-32-3-35-39","url":null,"abstract":"Aim. To study the prevalence of the small intestinal bacterial overgrowth syndrome in patients with irritable bowel syndrome with diarrhea who have had COVID-19 infection.Materials and methods. 60 patients with irritable bowel syndrome with diarrhea were examined. In 30 patients, irritable bowel syndrome was diagnosed after COVID-19 infection (main group). The comparison group consisted of 30 patients with classical stress-induced irritable bowel syndrome. The small intestinal bacterial overgrowth syndrome was diagnosed using a hydrogen breath test with lactulose loading in all patients.Results. In main group the small intestinal bacterial overgrowth syndrome was diagnosed in 93.3 % patients, which was statistically significantly higher (p < 0.01) relative to the comparison group — 60.0 % patientsConclusion. Irritable bowel syndrome in patients who have undergone COVID-19 occurs against the background of the small intestinal bacterial overgrowth syndrome development.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88933255","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":"Practical Recommendation of the Scientific Сommunity for Human Microbiome Research (CHMR) and the Russian Gastroenterological Association (RGA) on Small Intestinal Bacterial Overgrowth in Adults","authors":"V. Ivashkin, I. Maev, D. Abdulganieva, O. P. Alekseeva, S. Alekseenko, O. Zolnikova, N. Korochanskaya, O. Medvedev, E. Poluektova, V. Simanenkov, A. Trukhmanov, I. Khlynov, V. Tsukanov, O. Shifrin, K. Ivashkin, T. Lapina, R. Maslennikov, M. Fadeeva, A. Ulyanin","doi":"10.22416/1382-4376-2022-32-3-68-85","DOIUrl":"https://doi.org/10.22416/1382-4376-2022-32-3-68-85","url":null,"abstract":"Aim. To optimize the choice of treatment strategies by physicians and gastroenterologists to improve treatment and prevention of small intestinal bacterial overgrowth (SIBO) in adults.Key points. SIBO is a condition characterized by an increased amount and/or abnormal composition of the microbiota in the small intestine. Clinically, the syndrome is manifested by nonspecific gastroenterological complaints and the development of malabsorption syndrome. Most often, SIBO is associated with various chronic non- infectious diseases (both diseases of the gastrointestinal tract, and the cardiovascular system and the neuromuscular apparatus) and can affect the severity of their symptoms. Specific methods for diagnosing SIBO are the culture method and breath tests. The main approaches to the treatment of SIBO include the elimination of the underlying cause of its occurrence, the use of antibacterial drugs and adherence to dietary recommendations (elemental diet).Conclusion. Small intestinal bacterial overgrowth is common in patients with various diseases, but has non-specific manifestations, so proper diagnosis of this condition is required. SIBO therapy involves prescription of antibacterial agents, the most studied of which is the non-absorbable antibiotic rifaximin-α.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90068465","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":"Patient with Jaundice, Dyspnea and Hyperferritinemia after COVID-19","authors":"V. R. Grechishnikova, P. Tkachenko, M. Zharkova, T. Nekrasova, V. Ivashkin","doi":"10.22416/1382-4376-2022-32-3-57-67","DOIUrl":"https://doi.org/10.22416/1382-4376-2022-32-3-57-67","url":null,"abstract":"The aim: to highlight the importance of considering hemophagocytic lymphohistiocytosis in patients with jaundice of unclear origin and systemic inflammatory manifestations after coronavirus infection.Key points. A 64-y.o. patient was admitted to the hospital with jaundice, pruritus, fatigue, weight loss. The complaints occurred 2 weeks after discharge from the hospital for treatment of patients with coronavirus infection. Laboratory tests revealed signs of hepatic insufficiency, markers of cholestasis and inflammation persisted in time. Upon instrumental examination no signs of hepatosplenomegaly, biliary tree changes, intra- and extrahepatic obstruction were found. S. aureus was identified in blood cultures, CT scan of the facial skull bones showcased the focus of infection in the area of the roots of teeth 2.4 and 2.5. Therefore, antibiotics were prescribed. Subsequently, the patient's condition was complicated by the development of two episodes of acute respiratory distress syndrome, which occurred during the withdrawal of glucocorticosteroid therapy. Liver biopsy was performed, morphological study revealed signs of “vanishing bile duct” syndrome, excessive activation of macrophages and hemosiderosis of sinusoidal cells. Identified lesions can be found in hemophagocytic lymphohistiocytosis (HLH), a life-threatening complication of coronavirus infection. Glucocorticosteroids therapy, transfusions of human immunoglobulin, albumin, and parenteral nutrition have led to patient's condition improvement.Conclusion. COVID-19 provokes the development of secondary HLH 10 times more often than other respiratory viral infections. The possibility of hemophagocytic syndrome development should be considered, including cases of overlap syndrome with sepsis, in patients with unresolved jaundice, hyperferritinemia after coronavirus infection. Routinely used scales and criteria for diagnosis of HLH (H-score, HLH 2004) in such cases lacks sensitivity, therefore, careful analysis of clinical picture and exclusion of other causes of jaundice are required.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78278926","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":"Severe Diverticulitis Associated to Clostridioides difficile Infection in a 91 Year Old Patient (Clinical Case)","authors":"A. A. Makushina, L.N. Androsova, K. Puzakov, A. Okhlobystin, M. A. Tatarkina, O. Shifrin","doi":"10.22416/1382-4376-2022-32-2-93-98","DOIUrl":"https://doi.org/10.22416/1382-4376-2022-32-2-93-98","url":null,"abstract":"Aim. To present a clinical case of a 91-year-old patient with a severe course of diverticulitis combined with the development of Clostridioides difficile-associated disease.Key points. On admission the patient complained of pain in the left iliac region, increased body temperature, constipation and bloating. The medical history showed that constipation increased on the background of prolonged bed rest and discontinuation of psyllium. According to the laboratory and instrumental examinations, the patient had signs of acute diverticulitis, antibacterial therapy was corrected twice, positive dynamics of the condition was noted. However, a few days later, the patient developed a clinic of C. difficile-associated disease, which required the prescription of anticlostridial therapy (vancomycin), until the laboratory confirmation of the accession of this infection was obtained. Combined therapy of exacerbation of diverticular disease and C. difficile-associated disease made it possible to achieve a steady improvement of the condition.Conclusion. The exclusion of possible development of C. difficile-associated disease on the background or prior antibiotic therapy is an important condition for correct and adequate management of a patient with exacerbation of diverticular disease. If the patient develops a clinical picture of C. difficile-associated disease, treatment may be initiated before laboratory confirmation.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76483840","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}