Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)最新文献

{"title":"First-person pronouns as linguistic markers of depression among Brazilian youths.","authors":"Anna Viduani, Victor Cosenza, Helen L Fisher, Claudia Buchweitz, Natália Mota, Jader Piccin, Rivka Pereira, Brandon A Kohrt, Valeria Mondelli, Alastair van Heerden, Ricardo Matsumura Araújo, Christian Kieling","doi":"10.47626/1516-4446-2024-4058","DOIUrl":"https://doi.org/10.47626/1516-4446-2024-4058","url":null,"abstract":"<p><strong>Objective: </strong>Major depressive disorder (MDD) is a leading cause of disability among youth, yet identifying this condition remains challenging. Naturalistic communication offers a promising approach to enhance depression detection. Increased use of first-person singular pronouns (e.g., ''I'') has been linked to MDD, but its applicability to younger, non-English-speaking populations remains unclear.</p><p><strong>Methods: </strong>This study examined first-person pronoun use in Brazilian Portuguese-speaking adolescents with and without MDD and its relationship to self-reported and clinician-rated depressive symptoms. Fifty-two adolescents (13 with and 39 without MDD) from the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo) sample completed remote data collection using a WhatsApp chatbot, responding to questions via audio recordings. Transcripts were analyzed using the Linguistic Inquiry and Word Count (LIWC).</p><p><strong>Results: </strong>The MDD group used significantly more I-pronouns than non-MDD subjects (9.15 vs. 8.02%, t = -2.302, p = 0.026). Self-reported depressive symptomatology correlated with I-pronoun use (rho = 0.366, p = 0.008), but did not reach statistical significance for clinician-rated symptoms (rho = 0.248, p = 0.076).</p><p><strong>Conclusions: </strong>These findings support first-person singular pronouns as a potential linguistic marker of depression among Brazilian adolescents. This is the first study to replicate such results in a young, non-English-speaking sample using spoken speech, suggesting that integrating linguistic analysis with digital tools could enhance early detection efforts, particularly in resource-limited settings. Future research should explore use of I-pronouns alongside other linguistic and acoustic features to refine digital mental health screening approaches.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":"47 ","pages":"e20244058"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289749","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":"Substance use and climate change: Warming up the debate.","authors":"Gabriella da Silva Monteiro, Maria Angelica Torneli Ribeiro, Vitor Soares Tardelli, Thiago Marques Fidalgo","doi":"10.47626/1516-4446-2025-4319","DOIUrl":"10.47626/1516-4446-2025-4319","url":null,"abstract":"","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":"e20254319"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568320","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":"A randomized, double-blind, placebo-controlled trial of N-acetylcysteine as an adjuvant treatment for alcohol use disorder.","authors":"Jaqueline B Schuch, Fernanda Hansen, Thiago Hartmann, Daniela Benzano, Henrique M Gomes, José Cláudio F Moreira, Flavio Pechansky, Felix H P Kessler, Fabiana Galland, Daiane Silvello, Anne O Sordi, Lisia von Diemen","doi":"10.47626/1516-4446-2024-3541","DOIUrl":"https://doi.org/10.47626/1516-4446-2024-3541","url":null,"abstract":"<p><strong>Objective: </strong>We assessed the effect of N-acetylcysteine, as an adjuvant treatment, on treatment adherence (primary outcome) according to peripheral biomarkers and clinical improvement (secondary outcomes) in patients with alcohol use disorder.</p><p><strong>Methods: </strong>A 9-week randomized, double-blind, placebo-controlled clinical trial was conducted on 53 (n = 25 N-acetylcysteine, n = 28 placebo) inpatients with alcohol use disorder. Neuropeptide Y, oxidative stress and inflammatory biomarkers, and hepatic parameters were analyzed at 3 time points.</p><p><strong>Results: </strong>Seventeen (60.7%) patients in the placebo group and 16 (64%) patients in the N-acetylcysteine group completed the trial. Hepatic biomarker levels changed significantly over time (p < 0.001). Oxidized glutathione levels at admission were lower in the N-acetylcysteine group (ppairwise = 0.043). By the end of the study, both groups had similar oxidized glutathione levels (p = 0.868), and oxidized glutathione levels were lower in the placebo group. At the end of the intervention, superoxide dismutase activity had decreased and neuropeptide Y levels had increased in the N-acetylcysteine group. Both groups showed similar mean time to relapse, treatment adherence, and clinical improvement.</p><p><strong>Conclusions: </strong>Our findings reinforce the effects of alcohol on oxidative stress and neuropeptide Y parameters. However, our sample size may limit the generalizability of the results, especially for clinical outcomes. Future randomized clinical trials including patients with less severe alcohol use disorder and longer follow-up may be needed to determine whether N-acetylcysteine could help reduce the mental health burden of this disorder.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":"47 ","pages":"e20243541"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194434","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":"A systematic review of observational, naturalistic, and neurophysiological outcome measures of nonpharmacological interventions for autism.","authors":"Priscilla Brandi Gomes Godoy,&nbsp;Fernando Mitsuo Sumiya,&nbsp;Leonardo Seda,&nbsp;Elizabeth Shephard","doi":"10.47626/1516-4446-2021-2222","DOIUrl":"https://doi.org/10.47626/1516-4446-2021-2222","url":null,"abstract":"<p><strong>Objective: </strong>Naturalistic and neurophysiological assessments are relevant as outcome measures in autism intervention trials because they provide, respectively, ecologically valid information about functioning and underlying neurocognitive mechanisms. We conducted a systematic review to highlight which specific neurophysiological techniques, experimental tasks, and naturalistic protocols have been used to assess neural and behavioral functioning in autism intervention studies.</p><p><strong>Methods: </strong>Studies were collected from four electronic databases between October 2019 and February 2020: MEDLINE (via PubMed), PsycINFO, LILACS, and Web of Science, and were included if they used structured observational, naturalistic, or neurophysiological measures to assess the efficacy of a nonpharmacological intervention for ASD.</p><p><strong>Results: </strong>Fourteen different measures were used by 64 studies, with the Autism Diagnostic Observation Schedule the most frequently used instrument. Thirty-seven different coding systems of naturalistic measures were used across 51 studies, most of which used different protocols. Twentyfour neurophysiological measures were used in 16 studies, with different experimental paradigms and neurophysiological components used across studies.</p><p><strong>Conclusions: </strong>Cross-study variability in assessing the outcomes of autism interventions may obscure comparisons and conclusions about how different behavioral interventions affect autistic social communication and underlying neurophysiological mechanisms.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":"532-547"},"PeriodicalIF":0.0,"publicationDate":"2022-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/90/b9/bjp-44-05-532.PMC9561836.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40395333","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":"Immature defense mechanisms predict poor response to psychotherapy in major depressive patients with comorbid cluster B personality disorder.","authors":"Carolina Rheingantz Scaini,&nbsp;Igor Soares Vieira,&nbsp;Rosiene Machado,&nbsp;Taiane de Azevedo Cardoso,&nbsp;Thaise Mondin,&nbsp;Luciano Souza,&nbsp;Mariane Lopez Molina,&nbsp;Karen Jansen,&nbsp;Ricardo Azevedo da Silva","doi":"10.47626/1516-4446-2021-2214","DOIUrl":"https://doi.org/10.47626/1516-4446-2021-2214","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of defense mechanisms at baseline on depressive symptoms after brief psychotherapies and after 6-months of follow-up among depressed patients with and without cluster B personality disorders (PDs).</p><p><strong>Methods: </strong>This quasi-experimental study nested within a randomized clinical trial included a clinical sample of adults (18-60 years) diagnosed with major depressive disorder using the Mini-International Neuropsychiatric Interview. The Millon Clinical Multiaxial Inventory-III was applied to assess PD, the Defense Style Questionnaire 40 was used to analyze defense mechanisms, and the Beck Depression Inventory was used to measure the severity of depressive symptoms. Adjusted analysis was performed by linear regression.</p><p><strong>Results: </strong>The final sample consisted of 177 patients diagnosed with major depressive disorder, of whom 39.5% had cluster B PDs. Immature defenses at baseline significantly predicted the persistence of depressive symptoms at post-intervention and at 6-months of follow-up only in patients with PDs.</p><p><strong>Conclusion: </strong>In depressed patients with cluster B PDs, immature defenses predicted a poor response to brief therapies. The assessment of immature defenses at baseline can help identify patients at greater risk of poor therapeutic results and enable more appropriate treatment choices.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":"469-477"},"PeriodicalIF":0.0,"publicationDate":"2022-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/af/c8/bjp-44-05-469.PMC9561829.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40550945","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 mind possessed: well-being, personality, and cognitive characteristics of individuals regularly experiencing religious possession.","authors":"Roma Delmonte,&nbsp;Miguel Farias,&nbsp;Marco Aurélio V Bastos,&nbsp;Leandro Madeira,&nbsp;Beatriz Sonego","doi":"10.47626/1516-4446-2021-2414","DOIUrl":"https://doi.org/10.47626/1516-4446-2021-2414","url":null,"abstract":"<p><strong>Objective: </strong>To further our understanding of religious possession experiences by focusing on personality, cognitive, and quality of life outcomes.</p><p><strong>Methods: </strong>Data collection was undertaken at Umbanda sessions in Brazilian cities. Participants were mediums who regularly experienced possession (n=334) or those who attended the same rituals but had never been possessed (n=54).</p><p><strong>Results: </strong>We found that mediums were not significantly different across variables from the control group, except for anxiety, which was lower among mediums. Correlational and regression analysis showed that the level of meaningfulness attributed to possession and fusion with the spiritual entity were strongly positively correlated with most quality-of-life dimensions, and negatively with anxiety; in addition, level of meaningfulness predicted lower anxiety, and psychological quality of life was predicted by level of fusion and meaningfulness. Contrary to expectations, there were no detrimental effects of a lower level of bodily control over the possession experience.</p><p><strong>Conclusion: </strong>Together, these results suggest that individuals regularly experiencing possession within a religious context are psychologically similar to those who attend the same rituals without experiencing possession, and that the way they appraise their experiences as meaningful, as well as the level of spiritual fusion, are predictors of well-being.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":"486-494"},"PeriodicalIF":0.0,"publicationDate":"2022-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a6/b6/bjp-44-05-486.PMC9561835.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40665080","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":"Inflammatory cytokines and alcohol use disorder: systematic review and meta-analysis.","authors":"Helena F Moura,&nbsp;Fernanda Hansen,&nbsp;Fabiana Galland,&nbsp;Daiane Silvelo,&nbsp;Fernando P Rebelatto,&nbsp;Felipe Ornell,&nbsp;Raffael Massuda,&nbsp;Juliana N Scherer,&nbsp;Felipe Schuch,&nbsp;Felix H Kessler,&nbsp;Lisia von Diemen","doi":"10.47626/1516-4446-2021-1893","DOIUrl":"https://doi.org/10.47626/1516-4446-2021-1893","url":null,"abstract":"<p><strong>Objective: </strong>To assess differences in blood inflammatory cytokines between people with alcohol use disorder (AUD) and healthy controls (HC).</p><p><strong>Methods: </strong>Searches were performed from inception through April 14, 2021. Meta-analyses with random-effects models were used to calculate the standardized mean difference ([SMD], 95%CI), and potential sources of heterogeneity were explored trough meta-regressions and subgroup analysis.</p><p><strong>Results: </strong>The meta-analysis included 23 studies on the following 14 cytokines: tumor necrosis factor (TNF)-a, IL-1, IL-1RA, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-13, IL15, interferon (IFN)-g and sCD14. There were significantly higher concentrations of IL-6 (n=462 AUD and 408 HC; SMD = 0.523; 95%CI 0.136-0.909; p = 0.008) in AUD than HC. No significant differences were found in the other 13 cytokines.</p><p><strong>Conclusion: </strong>We found that IL-6 levels were significantly higher in individuals with AUD than HC and that other cytokines were not altered. This can be explained by the small number of studies, their methodological heterogeneity, and confounding factors (active use, abstinence, quantity, and physical or psychiatric illnesses, for example). Despite a great deal of evidence about alcohol and inflammatory diseases, studies assessing the role of neuroimmune signaling in the development and severity of AUD are still lacking.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":"548-556"},"PeriodicalIF":0.0,"publicationDate":"2022-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e3/1d/bjp-44-05-548.PMC9561830.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40418101","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":"Should psychiatrists be more cautious about the use of antipsychotics for patients with borderline personality disorder?","authors":"Rodolfo Furlan Damiano,&nbsp;Jair C Soares","doi":"10.47626/1516-4446-2022-2574","DOIUrl":"https://doi.org/10.47626/1516-4446-2022-2574","url":null,"abstract":"Five ago, Murray 1 published an asking whether ‘‘psychiatrists should be more cautious about the long-term prophylactic use of antipsychotics.’’ They brought up five important issues about the long-term use of antipsychotics in schizophrenia patients: a) the effects of antipsychotics on physical health; b) the effects of antipsychotics on brain structure; c) the efficacy of long-term antipsychotic use; d) antipsychotic-induced dopamine receptor supersensitivity, and e) treatment-resistant schizophrenia. However, they did not discuss the potential harm in other psychiatric diseases, such as in borderline personality disorder (BPD). In fact, no study has ever discussed the potential harm and iatrogenic potential of long-term antipsychotic use in BPD patients.","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":"467-468"},"PeriodicalIF":0.0,"publicationDate":"2022-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/be/2d/bjp-44-05-467.PMC9561842.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40151095","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":"Abuse of tropicamide eye drops: review of clinical data.","authors":"Val Bellman,&nbsp;Anastasia Ukolova,&nbsp;Elena Erovichenkova,&nbsp;Sarah Lam,&nbsp;Hirsch K Srivastava,&nbsp;Jared Bruce,&nbsp;Douglass M Burgess","doi":"10.47626/1516-4446-2021-2446","DOIUrl":"https://doi.org/10.47626/1516-4446-2021-2446","url":null,"abstract":"<p><p>Over the past 15 years, the increasing nonmedical use of tropicamide ophthalmic drops has been reported in Europe, coinciding with an increase in opioid addiction and drug-related mortality. Although tropicamide is generally known as a cheap alternative to heroin in Eastern Europe, it still appears to be a relatively new phenomenon that has arisen over the last decade. A narrative review was conducted of all the relevant sources published in more than five countries between January 1, 1975 and January 10, 2021. For bibliographic accuracy, the materials published in Russian and Italian were professionally translated to English. During the preparation of this report, we were able to interview five Russian-speaking patients who injected tropicamide in the past and we discuss another case of intravenous tropicamide use. This review was acknowledged by the institutional review board of the University of Missouri-Kansas City. All patients interviewed at the Unica Medical Center consented for their clinical information to be reported in a medical publication. We analyzed data from 50+ various sources and covered a variety of drug-related issues, including information on the extent, patterns, and trends in tropicamide use, its health consequences, and other clinical findings. The information provided in this article may help providers better detect tropicamide abuse and incorporate new rehabilitation strategies into the management of these patients.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":"522-531"},"PeriodicalIF":0.0,"publicationDate":"2022-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2b/ce/bjp-44-05-522.PMC9561840.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40333890","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":"Gender differences in progression to crack-cocaine use and the role of sexual and physical violence.","authors":"Fernando Pezzini Rebelatto,&nbsp;Felipe Ornell,&nbsp;Vinícius Serafini Roglio,&nbsp;Breno Sanvicente-Vieira,&nbsp;Rodrigo Grassi-Oliveira,&nbsp;Flavio Pechansky,&nbsp;Felix Henrique Paim Kessler,&nbsp;Jaqueline Bohrer Schuch,&nbsp;Lisia von Diemen","doi":"10.47626/1516-4446-2021-2248","DOIUrl":"https://doi.org/10.47626/1516-4446-2021-2248","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate whether progression from first drug use to crack-cocaine use differs according to gender, and whether the report of sexual or physical violence impacts the time of progression.</p><p><strong>Methods: </strong>We interviewed 896 crack-cocaine users (548 men; 348 women) from addiction treatment units. Cox regression models evaluated the time of progression from first drug use to crack use. We analyzed gender differences according to the absence or presence of sexual or physical violence, also considering whether violence, when present, had occurred before or after the onset of crack use.</p><p><strong>Results: </strong>Women presented a faster progression to crack use regardless of exposure to sexual or physical violence (p < 0.05). Compared to unexposed men, there was a similar progression for men exposed to sexual or physical violence before the first use of crack (p = 0.167 and p = 0.393, respectively). In both genders, we observed a faster progression among individuals exposed to these types of violence after the onset of crack use (p < 0.01).</p><p><strong>Conclusions: </strong>We found a faster progression to crack use among women and among individuals exposed to sexual and physical violence after the onset of crack use. These results encourage differentiated treatment strategies, focused on gender and individual characteristics.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":"478-485"},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ea/a8/bjp-44-05-478.PMC9561837.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40505207","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}