Current Urology最新文献

{"title":"Predicting urine culture results in candidates for lithotripsy.","authors":"Ofer N Gofrit,&nbsp;Roey Abudi,&nbsp;Amitay Lorber,&nbsp;Mordechai Duvdevani","doi":"10.1097/CU9.0000000000000117","DOIUrl":"https://doi.org/10.1097/CU9.0000000000000117","url":null,"abstract":"<p><strong>Background: </strong>Urological guidelines assert that \"urine culture should be obtained\" before surgical management of ureteral or kidney stones. Thus, many surgeries are delayed by 1-3 days until the results of urine culture are available. During this time, the patient frequently experience pain and possible kidney damage. We investigated the hypothesis that it is possible to predict the results of urine culture in candidates for surgical intervention using parameters that are accessible immediately upon admission.</p><p><strong>Materials and methods: </strong>A database of 1000 patients who underwent either percutaneous nephrolithotomy (PCNL) or ureteroscopy/retrograde intrarenal surgery was analyzed. Eleven parameters potentially related to urinary infections and accessible to the clinician at the emergency department were correlated with the preoperative urine culture results.</p><p><strong>Results: </strong>Of the patients, 234 (23.4 %) had positive cultures. On multivariate analysis, only sex, hydronephrosis grade, and history of previous nephrolithotomy were significantly associated with a positive preoperative urine culture. The risk of a positive culture can be easily determined from a simple table or an Excel-based calculator. This risk could be as low as 0.45% for a man without a history of PCNL and no hydronephrosis (4% in a woman with similar parameters) or as high as 79.5% in a man with a history of PCNL and hydronephrosis (85% in a woman with similar parameters).</p><p><strong>Conclusions: </strong>The risk of preoperative positive urine culture can be predicted using 3 parameters that are accessible upon admission. In low-risk cases, prompt surgical treatment can be provided, eliminating the anticipation time for urine culture results.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"17 2","pages":"113-117"},"PeriodicalIF":1.6,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/63/ca/curr-urol-17-113.PMC10489201.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10224032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelviureteric junction obstruction in adults: A systematic review of the literature.","authors":"Niall J O'Sullivan,&nbsp;Steven Anderson","doi":"10.1097/CU9.0000000000000154","DOIUrl":"https://doi.org/10.1097/CU9.0000000000000154","url":null,"abstract":"<p><strong>Background: </strong>Pelviureteric junction obstruction (PUJO) is a common urological disorder that can present at any stage of life. The underlying etiology in children has been well studied; however, a gap exists in the literature for the adult population. Herein, we performed a systematic review of the literature to evaluate the current evidence on the underlying etiologies of adult patients presenting with PUJO.</p><p><strong>Materials and methods: </strong>Four electronic databases were searched for relevant studies assessing the underlying etiologies of pelviureteric junction obstruction in adults. Studies were assessed for eligibility based on predefined inclusion and exclusion criteria, and a critical appraisal of methodological quality and risk of bias was performed. Finally, qualitative and quantitative data analyses were performed.</p><p><strong>Results: </strong>Twelve studies comprising a total of 513 patients with radiologically confirmed PUJO met the inclusion criteria and were included in our analysis. The most common finding was crossing vessels, which were observed in 50.5% of patients, followed by intrinsic ureteral stenosis (27.1%), adhesions (15.3%), and high insertion of the ureter (10.1%).</p><p><strong>Conclusions: </strong>The underlying etiologies of PUJO in adults remain unclear. This study indicated that obstruction secondary to crossing vessels is the most common cause of obstruction in adults and occurs more frequently than in the pediatric population.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"17 2","pages":"86-91"},"PeriodicalIF":1.6,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/21/d7/curr-urol-17-086.PMC10489243.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10218652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant chemotherapy after radical cystectomy: Do all patients who need chemotherapy after surgery actually receive it?","authors":"Roy Croock,&nbsp;Jonathan Modai,&nbsp;Yuval Avda,&nbsp;Igal Shpunt,&nbsp;Morad Jaber,&nbsp;Yamit Peretz,&nbsp;Yaniv Shilo,&nbsp;Dan Leibovici","doi":"10.1097/CU9.0000000000000099","DOIUrl":"https://doi.org/10.1097/CU9.0000000000000099","url":null,"abstract":"<p><strong>Background: </strong>Compliance with the guideline recommendations for neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer is incomplete. The adjuvant chemotherapy approach has the advantage of pathology-based decision-making, allowing for patient selection. In addition, radical surgery is not delayed and treatment-related toxicity does not impair surgical fitness. The proportion of patients who completed chemotherapy after cystectomy among those who were fit and in need of treatment were evaluated. The reasons for not completing adjuvant chemotherapy were determined.</p><p><strong>Materials and methods: </strong>We retrospectively evaluated all patients who had undergone radical cystectomy at our center over the last 7 years. Indications for adjuvant chemotherapy included pathological T > 2, any node+, or surgical margin involvement. Only patients who were fit for chemotherapy before surgery were included in the study.</p><p><strong>Results: </strong>Of the 52 patients with muscle-invasive bladder cancer, 14 received neoadjuvant chemotherapy or unfit for chemotherapy were excluded. Of the remaining 38 patients, 14 (37%) had bladder-confined cancers and did not require additional chemotherapy. Of the 24 patients who needed chemotherapy and were fit to receive it, 8 patients completed treatment (33%), and 3 discontinued treatment due to toxicity. Twelve patients (50%) declined chemotherapy, whereas 1 patient became unfit for chemotherapy after surgery.</p><p><strong>Conclusions: </strong>While the adjuvant chemotherapy approach could save unnecessary treatment in 37% of patients, two-thirds of those who needed chemotherapy did not complete it. Patient refusal was the primary reason for not receiving treatment.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"17 2","pages":"109-112"},"PeriodicalIF":1.6,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10489465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10221790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periurethral abscess etiology, risk factors, treatment options, and outcomes: A systematic review.","authors":"Arsalan Tariq,&nbsp;Adam G Stewart,&nbsp;Devang J Desai,&nbsp;Sumudu Britton,&nbsp;Nigel Dunglison,&nbsp;Rachel Esler,&nbsp;Matthew J Roberts","doi":"10.1097/CU9.0000000000000159","DOIUrl":"https://doi.org/10.1097/CU9.0000000000000159","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to describe patterns of presentation, etiology, risk factors, management, and treatment outcomes of periurethral abscesses using a systematic review framework.</p><p><strong>Materials and methods: </strong>After prospective registration on the PROSPERO database (CRD42020193063), a systematic review of Web of Science, Embase, PubMed, and Cochrane scientific databases was performed. Articles published between 1900 and 2021 were considered. Extracted data included symptoms, etiology, medical history, investigations, treatment, and outcomes. Collated data were analyzed using univariate methods.</p><p><strong>Results: </strong>Sixty articles met the inclusion criteria reporting on 270 patients (211 male, 59 female) with periurethral abscess. The most common clinical features were pain (41.5%), pyuria (41.5%), dysuria (38.5%), urinary frequency (32.3%), fever (25%), and a palpable mass (23%). Predisposing risk factors included the presence of a sexually transmitted infection or urinary tract infection (55.0%), urethral strictures (39.6%), and recent urethral instrumentation (18.7%). Management approaches included open incision and drainage (64.3%), conservative management with antibiotics (29.8%), and minimally invasive techniques (needle aspiration, endoscopic drainage). Time trend analysis of etiology revealed a decreased incidence of infection (sexually transmitted infection/urinary tract infection, human immunodeficiency virus) and higher incidence of diabetes mellitus and periurethral bulking injections in recent years.</p><p><strong>Conclusions: </strong>Periurethral abscesses may display a wide range of clinical features. Presentation, risk factors and underlying etiology vary with sex. The optimal management technique is guided by abscess size. Open incision and drainage combined with antibiotics continues to be the mainstay of management. However, minimally invasive techniques are gaining favor. To the authors' knowledge, this is the first systematic appraisal and management algorithm for periurethral abscess.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"17 2","pages":"100-108"},"PeriodicalIF":1.6,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/39/b2/curr-urol-17-100.PMC10489258.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10224026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparison of visual discomfort experienced by surgeons in wireless versus conventional endoscopy in laparoscopic surgery.","authors":"Hanjiang Xu,&nbsp;Di Niu,&nbsp;Cheng Yang,&nbsp;Zongyao Hao,&nbsp;Chaozhao Liang","doi":"10.1097/CU9.0000000000000182","DOIUrl":"https://doi.org/10.1097/CU9.0000000000000182","url":null,"abstract":"<p><strong>Background: </strong>This study was performed to introduce a new wireless endoscopic system. Research and development were based on fifth-generation transmission technology. Eye symptoms and visual discomfort induced by the novel endoscopic system were compared with those induced by the conventional endoscopic system before and during laparoscopic pelvic surgery.</p><p><strong>Materials and methods: </strong>Twenty surgeons successfully conducted laparoscopic pelvic surgeries using a conventional endoscopic system and a wireless endoscopic system. Subjective and objective data were measured to evaluate visual discomfort before and 2 hours after surgery.</p><p><strong>Results: </strong>In the conventional endoscopic and wireless endoscopic system groups, no significant differences were found in the presurgical or postsurgical questionnaires. In both groups, tear film breakup times significantly decreased after surgery. However, after comparing the 2 groups, no statistically significant difference was found.</p><p><strong>Conclusions: </strong>Compared with the conventional endoscopic system, the novel wireless endoscopic system does not cause additional visual discomfort for experienced surgeons.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"17 2","pages":"77-81"},"PeriodicalIF":1.6,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ef/21/curr-urol-17-077.PMC10489356.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10224028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of laparoscopic versus open simple nephrectomy in patients with xanthogranulomatous pyelonephritis: A singlecenter analysis of outcomes and predictors of surgical approaches and complications.","authors":"Francesco Chiancone,&nbsp;Francesco Persico,&nbsp;Marco Fabiano,&nbsp;Clemente Meccariello,&nbsp;Riccardo Giannella,&nbsp;Maurizio Fedelini,&nbsp;Giovanni Lughezzani,&nbsp;Paolo Fedelini","doi":"10.1097/CU9.0000000000000067","DOIUrl":"https://doi.org/10.1097/CU9.0000000000000067","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to compare the outcomes of open simple nephrectomy and laparoscopic simple nephrectomy in patients with xanthogranulomatous pyelonephritis (XGP) in a single-institutional retrospective study and to identify predictive factors of surgical approaches and complications.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed the data of 67 consecutive patients with a histopathological diagnosis of XGP who underwent either open simple nephrectomy (ON) or laparoscopic simple nephrectomy (LN) from January 2014 to April 2020. The primary endpoint was the evaluation of perioperative outcomes and complications. Secondary endpoints were to define factors influencing the surgical approach and the likelihood of postoperative complications.</p><p><strong>Results: </strong>Overall, 44 out of 67 patients (65.67%) underwent ON, while 23 (34.33%) underwent LN. Patients in the ON group experienced more postoperative pain according to the visual analogic scale <i>(p =</i> 0.032). Moreover, time to deambulation and time to return to full daily activities, assessed according to the 12-Item Short Form Survey physical and mental component summary scores questionnaires, were significantly shorter in the LN group <i>(p</i> = 0.021, <i>p <</i> 0.001, and <i>p <</i> 0.001, respectively). Of note, there were no significant differences in intraoperative and postoperative complication rates among the groups <i>(p</i> = 0.258 and <i>p</i> = 0.317, respectively). No conversion to open surgery was described. Logistic regression analysis demonstrated that urgency <i>(p</i> = 0.025) was the only predictor associated with a higher risk of intraoperative complications. However, no independent factors associated with postoperative complications or with the surgical approach of choice were found.</p><p><strong>Conclusions: </strong>Based on our results, laparoscopic treatment of XGP represents a feasible alternative to ON, resulting in less postoperative pain and faster recovery. In skilled hands, LN should be considered as the treatment of choice for XGP.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"17 2","pages":"135-140"},"PeriodicalIF":1.6,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10489480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10224030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited commentary: Comparison of visual discomfort experienced by surgeons in wireless versus conventional endoscopy in laparoscopic surgery.","authors":"José Ignacio Nolazco","doi":"10.1097/CU9.0000000000000184","DOIUrl":"https://doi.org/10.1097/CU9.0000000000000184","url":null,"abstract":"","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"17 2","pages":"84-85"},"PeriodicalIF":1.6,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7a/06/curr-urol-17-084.PMC10489351.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10224029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in incidence, staging, and survival of urologic cancers in patients under 65 living in the US-Mexico border region.","authors":"Zachariah D Taylor,&nbsp;Lauren Chew,&nbsp;Tyler Tumey,&nbsp;Charlotte C Gard,&nbsp;Michael E Woods","doi":"10.1097/CU9.0000000000000107","DOIUrl":"https://doi.org/10.1097/CU9.0000000000000107","url":null,"abstract":"<p><strong>Objectives: </strong>To describe and compare the incidence, stage at diagnosis, and survival for genitourinary cancers in the border regions and in Hispanic-Americans.</p><p><strong>Materials and methods: </strong>A population-based search was performed using the Surveillance, Epidemiology, and End Results Program 18 database and the Texas Cancer Registry from 2000 to 2017. Cox regression models were performed with adjusted for age, gender, race, cancer type, cancer stage, insurance status, and cause of death were used to compare cancer-specific survival.</p><p><strong>Results: </strong>A total of 63,236 kidney and renal pelvis, 38,398 bladder, 170,640 prostate, 24,313 testicular cancer cases were identified. Cancer-specific survival was found to be improved in Hispanic-Americans in kidney and renal pelvis (hazard ratio [HR], 0.903, 95% confidence interval [CI], 0.856-0.952, <i>p</i> = 0.0001), and bladder cancers (HR, 0.817, 95% CI, 0.743-0.898, <i>p</i> < 0.001), despite a more advanced stage at diagnosis in Hispanics with bladder cancer (<i>p</i> < 0.0074). Testicular cancer has a survival disadvantage for individuals living in the border region (HR, 1.315, 95% CI, 1.124-1.539, <i>p</i> = 0.0006).</p><p><strong>Conclusions: </strong>Disparities exist between Hispanic-Americans and Non-Hispanic White and also between individuals living in the border counties when compared to other regions. This is most significant in individuals with testicular cancer residing in the border region who demonstrate worse overall survival.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"17 2","pages":"118-124"},"PeriodicalIF":1.6,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/88/ae/curr-urol-17-118.PMC10489240.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10212122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do the incidence and severity of lower urinary tract symptoms measured by the international consultation on incontinence questionnaires correlate with urodynamic findings in patients with systemic sclerosis?","authors":"Amr A Faddan, M. Hassanien, E. Talaat, R. Gadelkareem","doi":"10.1097/cu9.0000000000000208","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000208","url":null,"abstract":"","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42099992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary testicular lymphoma: Clinical characteristics and oncological outcomes.","authors":"Alberto Artiles Medina,&nbsp;Javier Lorca Álvaro,&nbsp;Irene Carretero Del Barrio,&nbsp;Inés Laso García,&nbsp;Mónica García Cosío,&nbsp;Marina Mata Alcaraz,&nbsp;Manuel Hevia Palacios,&nbsp;Victoria Gómez Dos Santos,&nbsp;Francisco Javier Burgos Revilla","doi":"10.1097/CU9.0000000000000137","DOIUrl":"https://doi.org/10.1097/CU9.0000000000000137","url":null,"abstract":"<p><strong>Background: </strong>Primary testicular lymphoma (PTL) is a rare testicular malignancy, despite being considered the most common testicular tumor in patients older than 60 years. Primary testicular lymphoma represents only 1%-9% of testicular neoplasms. Few studies have been published regarding its clinical features and management. This study aimed to analyze the clinical characteristics and outcomes of PTL.</p><p><strong>Materials and methods: </strong>Orchiectomy specimens of 15 patients with PTL diagnosed during 2000-2020 at our institution were retrospectively studied. We collected information on demographic data, clinical features, management aspects, and outcomes of PTL treatment. Kaplan-Meier survival curves and Cox regression analyses were used to study survival.</p><p><strong>Results: </strong>The median patient age was 69 years (interquartile range, 61-72 years). The most prevalent clinical presentation was testicular swelling (80%), and only 13.33% of the patients presented with systemic symptoms. Central nervous system involvement was detected in 6 patients (40%). Of the 15 patients, 5 (33.33%) had stage IE and 10 (66.67%) had stage IVE lymphoma. Diffuse large B-cell lymphoma was the most common histological subtype. Twelve patients (80%) received chemotherapy. During follow-up, 4 patients (26.67%) relapsed. The recurrence rate in the contralateral testicle was 13.33%. The median cancer-specific survival was 21.58 months (95% confidence interval, 0-43.95 months). Univariate Cox regression analysis showed that central nervous system involvement and International Prognostic Index score were significantly associated with shorter cancer-specific survival.</p><p><strong>Conclusions: </strong>Primary testicular lymphoma has a high relapse rate and poor prognosis. Management strategies typically include radical orchiectomy and systemic chemotherapy. Central nervous system involvement and International Prognostic Index scores were associated with lymphoma-specific survival.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"17 2","pages":"130-134"},"PeriodicalIF":1.6,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/eb/fa/curr-urol-17-130.PMC10489500.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10224031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}