Progress in rehabilitation medicine最新文献

{"title":"Effects of Thoracic Spine Self-mobilization on Patients with Low Back Pain and Lumbar Hypermobility: A Randomized Controlled Trial.","authors":"Toru Yasuda,&nbsp;Sirinda Jaotawipart,&nbsp;Hironobu Kuruma","doi":"10.2490/prm.20230022","DOIUrl":"https://doi.org/10.2490/prm.20230022","url":null,"abstract":"<p><strong>Objectives: </strong>This study used magnetic resonance imaging (MRI) to investigate the effects of thoracic spine self-mobilization on patients with low back pain (LBP) and lumbar hypermobility.</p><p><strong>Methods: </strong>Twenty-four patients (15 men, 9 women) with LBP were randomly allocated to a thoracic spine self-mobilization group or sham group. The thoracic spine self-mobilization group performed thoracic spine active flexion and extension activities using two tennis balls fixed with athletic tape. Outcome measures were collected pre-intervention and after 4 weeks and included the Visual Analog Scale (VAS) for pain, the Oswestry Disability Index, lumbar rotation angle measured using MRI taken in the lateral position with 45° of trunk rotation, thoracolumbar rotation range of motion (ROM) in the sitting position, and stiffness of the erector spinae muscles. The effects of the intervention were analyzed using two-way repeated-measures analysis of variance (ANOVA), followed by multiple comparisons. The significance level was set at 5%.</p><p><strong>Results: </strong>The results of the two-way repeated measures ANOVA indicated that the main effect of the group was significant (P<0.05) for VAS, the sum of the lumbar rotation angle, and the thoracolumbar rotation ROM. A significant group-by-time interaction was found for the sum of lumbar rotation angles. The results of the multiple comparison tests for VAS, sum of the lumbar rotation angle from L1 to S1, and thoracolumbar rotation ROM were significantly different after 4 weeks.</p><p><strong>Conclusions: </strong>This study revealed a decrease in lumbar segmentation after thoracic spine mobilization. Thoracic spine mobilization may be effective in patients with LBP and hypermobility.</p>","PeriodicalId":74584,"journal":{"name":"Progress in rehabilitation medicine","volume":"8 ","pages":"20230022"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/30/6f/prm-8-20230022.PMC10359721.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9866168","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":"Effect of Vestibular Rehabilitation Program Using a Booklet in Patients with Chronic Peripheral Vestibular Hypofunction: A Randomized Controlled Trial.","authors":"Ryozo Tanaka,&nbsp;Hiroaki Fushiki,&nbsp;Reiko Tsunoda,&nbsp;Tomohiko Kamo,&nbsp;Takumi Kato,&nbsp;Hirofumi Ogihara,&nbsp;Masato Azami,&nbsp;Kaoru Honaga,&nbsp;Toshiyuki Fujiwara","doi":"10.2490/prm.20230002","DOIUrl":"https://doi.org/10.2490/prm.20230002","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigated the effects of a supervised home-based vestibular rehabilitation program using a booklet on gait function and dizziness in patients with chronic peripheral vestibular hypofunction.</p><p><strong>Methods: </strong>This was a non-blinded, randomized, controlled trial. Patients (n=42) with chronic peripheral vestibular hypofunction were randomly divided into the vestibular rehabilitation group (VR group; n=20) or the control group (n=22). Patients in the VR group received a supervised home-based vestibular rehabilitation program using a booklet in addition to physician care for 4 weeks. The physical therapist checked the home program when the VR group visited the outpatient clinic once a week. Patients in the control group received physician care only during the trial period. The primary outcome was functional gait assessment (FGA). The secondary outcomes were the dynamic gait index (DGI) and the dizziness handicap inventory (DHI).</p><p><strong>Results: </strong>Two-way repeated measures analysis of variance showed a significant interaction for FGA, DGI, DHI total, and DHI emotional scores (P<0.05) with the VR group improving more than the control group. No significant interactions were found for DHI physical and DHI functional scores (P≥0.05).</p><p><strong>Conclusions: </strong>The home-based vestibular rehabilitation program in this study was effective in improving gait function and dizziness in patients with chronic peripheral vestibular hypofunction. Regular supervision may have improved adherence to home exercise and contributed to the effectiveness of vestibular rehabilitation.</p>","PeriodicalId":74584,"journal":{"name":"Progress in rehabilitation medicine","volume":"8 ","pages":"20230002"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/06/34/prm-8-20230002.PMC9836908.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10632345","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":"Three-dimensional Gait Analysis Spanning 13 Years in a Patient with Unilateral Premature Physeal Arrest: A Case Report","authors":"Hiroki Fujita, Atsushi Teramoto, Hiroyori Fusagawa, Toshihiko Yamashita, and Paulo Selber","doi":"10.2490/prm.20230029","DOIUrl":"https://doi.org/10.2490/prm.20230029","url":null,"abstract":"Background: There are numerous etiologies relating to physeal arrest. The clinical manifestations of physeal arrest may include limb length discrepancy (LLD) and bone malalignment, especially in younger children with more growth ahead of them.","PeriodicalId":74584,"journal":{"name":"Progress in rehabilitation medicine","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135549869","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":"Effect of Leg Length Discrepancy on Dynamic Gait Stability.","authors":"Issei Miyagi,&nbsp;Mizuho Ohta,&nbsp;Makoto Tamari","doi":"10.2490/prm.20230013","DOIUrl":"https://doi.org/10.2490/prm.20230013","url":null,"abstract":"<p><strong>Objectives: </strong>: It is unclear whether the increased center of mass lateral shift during gait induced by leg length difference induces lateral instability. The purpose of this study was to investigate the effect of leg length discrepancy (LLD) on dynamic gait stability and the compensatory kinematic and dynamic strategies for this effect by using the extrapolated center of mass and margin of stability.</p><p><strong>Methods: </strong>: Nineteen healthy male participants walked without insoles (no LLD condition; 0 cm) and with added insoles (LLD condition; 3 cm). Kinematic and kinetic data were analyzed using a three-dimensional motion analyzer and force plates; the values were compared between the two conditions. Correlation analysis was performed on the parameters and the margin of stability and significant changes were identified.</p><p><strong>Results: </strong>Compared with the no-LLD condition, in the LLD condition, lateral stability was maintained on both the short leg side and the long leg side. Nonetheless, changes in joint angles and muscle activity on the frontal plane were observed on the short leg side, although the correlations were not significant. On the long leg side, a moderate negative correlation was found between the lateral flexion angle of the trunk and the margin of stability (<i>r</i>=-0.56, P=0.011).</p><p><strong>Conclusions: </strong>The short leg side may compensate for lateral stability by complex changes in joint angles and muscle activity, and the long leg side may compensate for lateral stability by actively adjusting the trunk lateral flexion angle.</p>","PeriodicalId":74584,"journal":{"name":"Progress in rehabilitation medicine","volume":"8 ","pages":"20230013"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d4/4b/prm-8-20230013.PMC10118994.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9756724","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":"Swallow-related Brain Activity in Post-total Laryngectomy Patients: A Case Series Study.","authors":"Akari Ogawa,&nbsp;Satoko Koganemaru,&nbsp;Toshimitsu Takahashi,&nbsp;Yuu Takemura,&nbsp;Hiroshi Irisawa,&nbsp;Kazutaka Goto,&nbsp;Masao Matsuhashi,&nbsp;Tatsuya Mima,&nbsp;Takashi Mizushima,&nbsp;Kenji Kansaku","doi":"10.2490/prm.20230026","DOIUrl":"https://doi.org/10.2490/prm.20230026","url":null,"abstract":"<p><strong>Background: </strong>Total laryngectomy is a surgical procedure to completely remove the hyoid bone, larynx, and associated muscles as a curative treatment for laryngeal cancer. This leads to insufficient swallowing function with compensative movements of the residual tongue to propel the food bolus to the pharynx and esophagus. However, the neurophysiological mechanisms of compensative swallowing after total laryngectomy remain unclear. Recently, swallowing-related cortical activation such as event-related desynchronization (ERD) during swallowing has been reported in healthy participants and neurological patients with dysphagia. Abnormal ERD elucidates the pathophysiological cortical activities that are related to swallowing. No report has investigated ERD in post-total laryngectomy patients.</p><p><strong>Case: </strong>We investigated ERD during volitional swallowing using electroencephalography in three male patients after total laryngectomy for laryngeal cancer (age and time after surgery: Case 1, 75 years, 10 years; Case 2, 85 years, 19 years; Case 3, 73 years, 19 years). In video fluorographic swallowing studies, we observed compensatory tongue movements such as posterior-inferior retraction of the tongue and contact on the posterior pharyngeal wall in all three cases. Significant ERD was localized in the bilateral medial sensorimotor areas and the left lateral parietal area in Case 1, in the bilateral frontal and left temporal areas in Case 2, and in the left prefrontal and premotor areas in Case 3.</p><p><strong>Discussion: </strong>These results suggest that cortical activities related to swallowing might reflect cortical reorganization for modified swallowing movements of residual tongue muscles to compensate for reduced swallowing pressure in patients after total laryngectomy.</p>","PeriodicalId":74584,"journal":{"name":"Progress in rehabilitation medicine","volume":"8 ","pages":"20230026"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2c/df/prm-8-20230026.PMC10468693.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10525107","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":"A Case of Tardive Dystonia with Task Specificity Confined to the Lower Extremities only during Walking.","authors":"Kozo Hatori,&nbsp;Yasuhiro Tagawa,&nbsp;Taku Hatano,&nbsp;Osamu Akiyama,&nbsp;Nana Izawa,&nbsp;Akihide Kondo,&nbsp;Kazunori Sato,&nbsp;Ayami Watanabe,&nbsp;Nobutaka Hattori,&nbsp;Toshiyuki Fujiwara","doi":"10.2490/prm.20230014","DOIUrl":"https://doi.org/10.2490/prm.20230014","url":null,"abstract":"<p><strong>Background: </strong>Task-specific dystonia (TSD) confined to the lower extremities (LE) is relatively rare. This report describes dystonia confined to the LE only during forward walking. This case required careful neurological and diagnostic assessment because the patient was taking several neuropsychiatric drugs that cause symptomatic dystonia, such as aripiprazole (ARP).</p><p><strong>Case: </strong>A 53-year-old man visited our university hospital with a complaint of abnormalities in the LE that appeared only during walking. Neurological examinations other than walking were normal. Brain magnetic resonance imaging revealed meningioma in the right sphenoid ridge. The patient had been treated for depression with neuropsychiatric medications for a long time, and his abnormal gait appeared about 2 years after additional administration of ARP. After the meningioma was removed, his symptoms remained. Surface electromyography showed dystonia in both LE during forward walking, although his abnormal gait appeared to be accompanied by spasticity. The patient was tentatively diagnosed with tardive dystonia (TD). Although dystonia did not disappear clinically, it was alleviated after discontinuing ARP. Administration of trihexyphenidyl hydrochloride and concomitant rehabilitation improved his dystonia until return to work, but some residual gait abnormalities remained.</p><p><strong>Discussion: </strong>We report an unusual case of TD with task specificity confined to the LE. The TD was induced by the administration of ARP in combination with multiple psychotropic medications. Careful consideration was required for clinical diagnosis, rehabilitation, and assessment of its relevance to TSD.</p>","PeriodicalId":74584,"journal":{"name":"Progress in rehabilitation medicine","volume":"8 ","pages":"20230014"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/27/76/prm-8-20230014.PMC10172006.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9470871","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":"Disorders of Consciousness after Subacute Stroke Might Partly be Caused by Carnitine Deficiency: Two Case Reports.","authors":"Makoto Ueno,&nbsp;Seiji Miura,&nbsp;Rintaro Ohama,&nbsp;Megumi Shimodozono","doi":"10.2490/prm.20230019","DOIUrl":"https://doi.org/10.2490/prm.20230019","url":null,"abstract":"<p><strong>Background: </strong>Carnitine is a vital human nutrient. Although there are many reports on carnitine deficiency, most studies have been conducted on children, patients with severe mental and physical disabilities, epileptic patients, patients with liver cirrhosis, and dialysis patients. To the best of our knowledge, there are no reports on carnitine administration for disorders of consciousness after stroke. We report two such cases in which carnitine administration improved disorders of consciousness.</p><p><strong>Cases: </strong>Case 1 was a woman in her sixties who was admitted to our rehabilitation center 4 months after the onset of subarachnoid hemorrhage. After admission, her disorders of consciousness worsened even though she was actively undergoing rehabilitation. Suspecting carnitine deficiency, we administered 1500 mg/day of L-carnitine, which resulted in improvement of her disorders of consciousness and disappearance of symptoms such as convulsions. Case 2 was a man in his thirties who was admitted to our rehabilitation center 5 months after the onset of cerebral hemorrhage. During active rehabilitation, he suffered worsening disorders of consciousness, convulsions, and cramps. We found carnitine deficiency with a blood carnitine concentration of 21 mg/dL, so we administered 1500 mg/day of L-carnitine; symptoms of disorders of consciousness and convulsions then improved.</p><p><strong>Discussion: </strong>It is possible that carnitine deficiency has been overlooked in some patients in rehabilitation wards, and measurement of ammonia might facilitate its detection. Because carnitine deficiency can interfere with active rehabilitation, nutritional management with attention to carnitine deficiency could be important during rehabilitation.</p>","PeriodicalId":74584,"journal":{"name":"Progress in rehabilitation medicine","volume":"8 ","pages":"20230019"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/88/cf/prm-8-20230019.PMC10307532.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10105604","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":"In-hospital Rehabilitation Therapy Outcomes in Adult Down’s Syndrome Patients with Community-acquired Pneumonia: A Nationwide Observational Study","authors":"Takaaki Ikeda, Upul Cooray, Toshifumi Yodoshi, Makoto Kaneko, Ken Osaka, Masayasu Murakami","doi":"10.2490/prm.20230033","DOIUrl":"https://doi.org/10.2490/prm.20230033","url":null,"abstract":"Objectives : There has been no analysis of the effects of in-hospital rehabilitation on adult patients with Down’s Syndrome (DS) after hospitalization for community-acquired pneumonia (CAP). Medical claims data retrospectively collected nationwide were used to examine outcomes at discharge.","PeriodicalId":74584,"journal":{"name":"Progress in rehabilitation medicine","volume":"88 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135753595","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":"Effect of Repetitive Transcranial Magnetic Stimulation on Long Coronavirus Disease 2019 with Fatigue and Cognitive Dysfunction.","authors":"Nobuyuki Sasaki,&nbsp;Masato Yamatoku,&nbsp;Tomoya Tsuchida,&nbsp;Hiroyuki Sato,&nbsp;Keiichiro Yamaguchi","doi":"10.2490/prm.20230004","DOIUrl":"https://doi.org/10.2490/prm.20230004","url":null,"abstract":"<p><strong>Objectives: </strong>There is no established treatment for chronic fatigue and various cognitive dysfunctions (brain fog) caused by long coronavirus disease 2019 (COVID-19). We aimed to clarify the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for treating these symptoms.</p><p><strong>Methods: </strong>High-frequency rTMS was applied to occipital and frontal lobes in 12 patients with chronic fatigue and cognitive dysfunction 3 months after severe acute respiratory syndrome coronavirus 2 infection. Before and after ten sessions of rTMS, Brief Fatigue Inventory (BFI), Apathy Scale (AS), and Wechsler Adult Intelligence Scale-fourth edition (WAIS4) were determined and <i>N</i>-isopropyl-<i>p</i>-[¹²³I]iodoamphetamine single photon emission computed tomography (SPECT) was performed.</p><p><strong>Results: </strong>Twelve subjects completed ten sessions of rTMS without adverse events. The mean age of the subjects was 44.3 ± 10.7 years, and the mean duration of illness was 202.4 ± 114.5 days. BFI, which was 5.7 ± 2.3 before the intervention, decreased significantly to 1.9 ± 1.8 after the intervention. The AS was significantly decreased after the intervention from 19.2 ± 8.7 to 10.3 ± 7.2. All WAIS4 sub-items were significantly improved after rTMS intervention, and the full-scale intelligence quotient increased from 94.6 ± 10.9 to 104.4 ± 13.0. Hypoperfusion in the bilateral occipital and frontal lobes observed on SPECT improved in extent and severity after ten sessions of rTMS.</p><p><strong>Conclusions: </strong>Although we are still in the early stages of exploring the effects of rTMS, the procedure has the potential for use as a new non-invasive treatment for the symptoms of long COVID.</p>","PeriodicalId":74584,"journal":{"name":"Progress in rehabilitation medicine","volume":"8 ","pages":"20230004"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/95/bf/prm-8-20230004.PMC9968785.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9385399","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":"Non-invasive Brain Stimulation in Post-stroke Dysphagia Rehabilitation: A Narrative Review of Meta-analyses in 2022.","authors":"Sumiya Shibata,&nbsp;Satoko Koganemaru,&nbsp;Tatsuya Mima","doi":"10.2490/prm.20230015","DOIUrl":"https://doi.org/10.2490/prm.20230015","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to update the current knowledge on non-invasive brain stimulation (NIBS) effects, such as repetitive transcranial brain stimulation and transcranial direct current stimulation, in patients with post-stroke dysphagia (PSD).</p><p><strong>Methods: </strong>We summarized the basic principles and therapeutic strategies of NIBS. We then reviewed nine meta-analyses from 2022 that investigated the efficacy of NIBS in PSD rehabilitation.</p><p><strong>Results: </strong>Although dysphagia is a common and devastating sequela of stroke, the efficacy of conventional swallowing therapies remains controversial. NIBS techniques have been proposed as promising approaches for managing PSD via neuromodulation. Recent meta-analyses have shown that NIBS techniques are beneficial for the recovery of patients with PSD.</p><p><strong>Conclusions: </strong>NIBS has the potential to become a novel alternative treatment for PSD rehabilitation.</p>","PeriodicalId":74584,"journal":{"name":"Progress in rehabilitation medicine","volume":"8 ","pages":"20230015"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c9/52/prm-8-20230015.PMC10206280.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9520299","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}