Endometriosis can be described as the deposition of functional tissue of the endometrium or glands in areas other than the uterus (1). There are two types of endometrial tissue depositions, namely, pelvic and extrapelvic. The deposition of glands in the ovaries, fallopian tubes, and their associated peritoneum is referred to as pelvic endometriosis. Extra pelvic endometriosis is extremely rare and generally involves the gastrointestinal and urinary tracts. The other involved sites are the lungs, central nervous system, surgical scars, and the skin. Endometriosis is estrogen-dependent, and there are many theories describing its pathogenesis (2). It generally affects 5-10% of women in the third decade of life (3). When glands from the endometrium deposit in the lungs or the pleura, it is called thoracic endometriosis syndrome (TES). It is a rare type of endometriosis characterized by catamenial pneumothorax, hemoptysis, pneumothorax, and pulmonary nodules (4) and is commonly mistaken for tuberculosis endemic in countries such as India. This report describes the scenario of a woman aged 26 years old with endometriosis who was presented with dyspnea, hemoptysis, and chest pain. Case Report A married woman aged 26 years with two previous vaginal births was presented with complaints of hemoptysis, chest pain, and dyspnea for about 4 months which was most severe during menstruation and subsided slowly by day 5 or 6 of the menstrual cycle. There was also a history of dysmenorrhea for the last 3 years although there was no history of fever, loss of weight, or loss of appetite. Her symptoms had initially begun about 8 months after the birth of her second child and the hemoptysis and chest pain had progressively increased over a period of time. Suspecting that she might have contracted pulmonary tuberculosis, she underwent anti-tubercular therapy by a general practitioner 4 months ago although she did not improve symptomatically. Then, she was presented with amenorrhea for about two months. Since she did want to continue with the pregnancy, she requested for the termination of pregnancy and permanent sterilization. On detailed history taking, it was found that during the two months of amenorrhea, hemoptysis had subsided. She did not visit the hospital initially thinking that the hemoptysis had subsided because of anti-tubercular therapy. Her complete blood count, erythrocyte sedimentation rate, coagulation profile, and liver and kidney functions were Abstract Introduction: Endometriosis is the deposition of endometrial glands and stroma outside the uterus and can be of pelvic or extrapelvic type. Thoracic endometriosis syndrome (TES) is associated with endometriosis in the pleura or the lungs, as well as cyclical pneumothorax, chest pain, haemoptysis, and pulmonary nodules. TES can be misdiagnosed for the more prevalent pulmonary tuberculosis in countries such as India. Case Report: A married woman aged 26 years old was presented with complaints of hemoptys
{"title":"Catamenial Hemoptysis Managed With Medroxyprogesterone Acetate: A Management Dilemma","authors":"A. Rao, R. Rao","doi":"10.15296/IJWHR.2021.27","DOIUrl":"https://doi.org/10.15296/IJWHR.2021.27","url":null,"abstract":"Endometriosis can be described as the deposition of functional tissue of the endometrium or glands in areas other than the uterus (1). There are two types of endometrial tissue depositions, namely, pelvic and extrapelvic. The deposition of glands in the ovaries, fallopian tubes, and their associated peritoneum is referred to as pelvic endometriosis. Extra pelvic endometriosis is extremely rare and generally involves the gastrointestinal and urinary tracts. The other involved sites are the lungs, central nervous system, surgical scars, and the skin. Endometriosis is estrogen-dependent, and there are many theories describing its pathogenesis (2). It generally affects 5-10% of women in the third decade of life (3). When glands from the endometrium deposit in the lungs or the pleura, it is called thoracic endometriosis syndrome (TES). It is a rare type of endometriosis characterized by catamenial pneumothorax, hemoptysis, pneumothorax, and pulmonary nodules (4) and is commonly mistaken for tuberculosis endemic in countries such as India. This report describes the scenario of a woman aged 26 years old with endometriosis who was presented with dyspnea, hemoptysis, and chest pain. Case Report A married woman aged 26 years with two previous vaginal births was presented with complaints of hemoptysis, chest pain, and dyspnea for about 4 months which was most severe during menstruation and subsided slowly by day 5 or 6 of the menstrual cycle. There was also a history of dysmenorrhea for the last 3 years although there was no history of fever, loss of weight, or loss of appetite. Her symptoms had initially begun about 8 months after the birth of her second child and the hemoptysis and chest pain had progressively increased over a period of time. Suspecting that she might have contracted pulmonary tuberculosis, she underwent anti-tubercular therapy by a general practitioner 4 months ago although she did not improve symptomatically. Then, she was presented with amenorrhea for about two months. Since she did want to continue with the pregnancy, she requested for the termination of pregnancy and permanent sterilization. On detailed history taking, it was found that during the two months of amenorrhea, hemoptysis had subsided. She did not visit the hospital initially thinking that the hemoptysis had subsided because of anti-tubercular therapy. Her complete blood count, erythrocyte sedimentation rate, coagulation profile, and liver and kidney functions were Abstract Introduction: Endometriosis is the deposition of endometrial glands and stroma outside the uterus and can be of pelvic or extrapelvic type. Thoracic endometriosis syndrome (TES) is associated with endometriosis in the pleura or the lungs, as well as cyclical pneumothorax, chest pain, haemoptysis, and pulmonary nodules. TES can be misdiagnosed for the more prevalent pulmonary tuberculosis in countries such as India. Case Report: A married woman aged 26 years old was presented with complaints of hemoptys","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2020-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81441775","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}
Nazli Ghamari, Loghman Ghaderi, Tannaz Hasani Moghaddam, F. Mallah
Breast cancer is a type of cancer that starts in the breast tissue and can spread to other nearby tissues in addition to affecting the entire breast tissue (1). It is the most common cancer worldwide, causing extensive mortality and many complications (2-4). The incidence of breast cancer is globally increasing, especially in developing countries. Notably, about 6 million women with breast cancer were globally identified during 2008-2013 (5). More than 255 000 new cases of breast cancer occurred in the United States in 2017. Meanwhile, the annual incidence of breast cancer is 33 cases per 100 000 people in Iran, and the highest rate has occurred in Tehran, Isfahan, Yazd, Markazi, and Fars provinces (6). One of the concerns associated with breast cancer is its experience during pregnancy (7). Pregnancy-associated breast cancer refers to cancer that occurs during pregnancy, breastfeeding, or one year after delivery. It is the second most common cancer in pregnancy, which rarely occurs and does not cause many deaths (8, 9). Diagnostic and therapeutic interventions during this period are implemented with special considerations. Women with breast cancer are clearly at a more advanced stage of the disease during pregnancy and usually have a poorer prognosis (10,11). One of the major challenges in diagnosis and treatment during this period is maintaining a balance in the aggressive care of these patients and appropriate treatments to maintain the health of the fetus/ baby. Given that the occurrence of this cancer during pregnancy can have adverse effects on the health of the mother, the baby, and the fetus, the current study aimed to investigate the factors affecting the incidence of this type of cancer during pregnancy.
{"title":"Breast Cancer and Ways to Diagnose the Risk Factors and Treat it During Pregnancy: A Narrative Review","authors":"Nazli Ghamari, Loghman Ghaderi, Tannaz Hasani Moghaddam, F. Mallah","doi":"10.15296/IJWHR.2021.17","DOIUrl":"https://doi.org/10.15296/IJWHR.2021.17","url":null,"abstract":"Breast cancer is a type of cancer that starts in the breast tissue and can spread to other nearby tissues in addition to affecting the entire breast tissue (1). It is the most common cancer worldwide, causing extensive mortality and many complications (2-4). The incidence of breast cancer is globally increasing, especially in developing countries. Notably, about 6 million women with breast cancer were globally identified during 2008-2013 (5). More than 255 000 new cases of breast cancer occurred in the United States in 2017. Meanwhile, the annual incidence of breast cancer is 33 cases per 100 000 people in Iran, and the highest rate has occurred in Tehran, Isfahan, Yazd, Markazi, and Fars provinces (6). One of the concerns associated with breast cancer is its experience during pregnancy (7). Pregnancy-associated breast cancer refers to cancer that occurs during pregnancy, breastfeeding, or one year after delivery. It is the second most common cancer in pregnancy, which rarely occurs and does not cause many deaths (8, 9). Diagnostic and therapeutic interventions during this period are implemented with special considerations. Women with breast cancer are clearly at a more advanced stage of the disease during pregnancy and usually have a poorer prognosis (10,11). One of the major challenges in diagnosis and treatment during this period is maintaining a balance in the aggressive care of these patients and appropriate treatments to maintain the health of the fetus/ baby. Given that the occurrence of this cancer during pregnancy can have adverse effects on the health of the mother, the baby, and the fetus, the current study aimed to investigate the factors affecting the incidence of this type of cancer during pregnancy.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2020-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78396836","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}
Zeinab Zarabadipour, H. Pakniat, M. R. Niaraki, N. Azh
Postpartum hemorrhage (PPH) refers to the blood loss of more than 500 cc after completing the third stage of labor (1,2). Nonetheless, this estimation is generally only half of the actual blood loss based on the evidence (3). In addition, PPH is known as one of the major reasons for maternal mortality (4). In other words, 28% and 10% of maternal deaths in developing and developed countries are related to PPH, respectively (2,5,6). Further, PPH is characterized by a 10% drop in hematocrit levels and the need for postpartum blood transfusions (7). It could lead to hypovolemic shock, disseminated intravascular coagulation, and acute renal failure (8, 9). Treatments should address the causes of PPH. The possible causes of uterine postpartum bleeding are trauma, retained placenta, and uterine atony (10-12). Uterotonic drugs such as oxytocin, ergo derivatives, and misoprostol are used as the first line of treatments for PPH in Iran (7). Except for uterine massage, the other treatments of PPH have disadvantages on the mother (e.g., headache, vomiting, the elevation of blood pressure, and the like) or breastfeeding (1,13). Consequently, preventing PPH is highly important. Reducing hemorrhage is usually implemented by the routine active management of placenta delivery by drug using to contract the uterus such as oxytocin (11). Today, ice therapy is used as one of the new methods for the treatment of many diseases, even cancer by lessening pain, inflammation, and vasoconstriction (14). It can be one of the useful methods for preventing uterine atony and PPH (15). Based on the evidence, placing an icebag on the lower abdomen for cooling the uterus is one of the standard non-pharmacological prophylactic strategies to prevent PPH in low-risk women in Japan (15), and its argument is that cold compresses would contract the myometrium and decreases the amount of blood flow (16). In contrast, some studies have reported conflicting results about the effectiveness of icebag in preventing uterine atony in normal delivery (16,17). This study was designed to reduce maternal deaths as an important factor for children’s growth, specifically in poor countries (18) by using available methods such Abstract Objectives: Using uterotonic drugs to prevent postpartum hemorrhage is recommended in the health centers. However, the related studies are contradictory, thus the evaluation of non-invasive methods with minimal side-effects such as icepack would be useful. Traditionally, icepack has been applied, along with drugs in most deliveries in postpartum hemorrhage (PPH) in Iran although it has not evidenced yet. Therefore, the present study aimed to evaluate the effect of the icepack on blood loss. Materials and Methods: This study was a randomized controlled trial. The sample size included 58 women including 29 intervention and 29 control groups. The intervention group benefited from an icepack placed on the lower abdomen 2 hours after placental delivery while the control group
{"title":"Comparison of the Effect of Cooling the Lower Abdomen and Oxytocin on Postpartum Blood Loss in Vaginal Delivery","authors":"Zeinab Zarabadipour, H. Pakniat, M. R. Niaraki, N. Azh","doi":"10.15296/IJWHR.2021.19","DOIUrl":"https://doi.org/10.15296/IJWHR.2021.19","url":null,"abstract":"Postpartum hemorrhage (PPH) refers to the blood loss of more than 500 cc after completing the third stage of labor (1,2). Nonetheless, this estimation is generally only half of the actual blood loss based on the evidence (3). In addition, PPH is known as one of the major reasons for maternal mortality (4). In other words, 28% and 10% of maternal deaths in developing and developed countries are related to PPH, respectively (2,5,6). Further, PPH is characterized by a 10% drop in hematocrit levels and the need for postpartum blood transfusions (7). It could lead to hypovolemic shock, disseminated intravascular coagulation, and acute renal failure (8, 9). Treatments should address the causes of PPH. The possible causes of uterine postpartum bleeding are trauma, retained placenta, and uterine atony (10-12). Uterotonic drugs such as oxytocin, ergo derivatives, and misoprostol are used as the first line of treatments for PPH in Iran (7). Except for uterine massage, the other treatments of PPH have disadvantages on the mother (e.g., headache, vomiting, the elevation of blood pressure, and the like) or breastfeeding (1,13). Consequently, preventing PPH is highly important. Reducing hemorrhage is usually implemented by the routine active management of placenta delivery by drug using to contract the uterus such as oxytocin (11). Today, ice therapy is used as one of the new methods for the treatment of many diseases, even cancer by lessening pain, inflammation, and vasoconstriction (14). It can be one of the useful methods for preventing uterine atony and PPH (15). Based on the evidence, placing an icebag on the lower abdomen for cooling the uterus is one of the standard non-pharmacological prophylactic strategies to prevent PPH in low-risk women in Japan (15), and its argument is that cold compresses would contract the myometrium and decreases the amount of blood flow (16). In contrast, some studies have reported conflicting results about the effectiveness of icebag in preventing uterine atony in normal delivery (16,17). This study was designed to reduce maternal deaths as an important factor for children’s growth, specifically in poor countries (18) by using available methods such Abstract Objectives: Using uterotonic drugs to prevent postpartum hemorrhage is recommended in the health centers. However, the related studies are contradictory, thus the evaluation of non-invasive methods with minimal side-effects such as icepack would be useful. Traditionally, icepack has been applied, along with drugs in most deliveries in postpartum hemorrhage (PPH) in Iran although it has not evidenced yet. Therefore, the present study aimed to evaluate the effect of the icepack on blood loss. Materials and Methods: This study was a randomized controlled trial. The sample size included 58 women including 29 intervention and 29 control groups. The intervention group benefited from an icepack placed on the lower abdomen 2 hours after placental delivery while the control group","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2020-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82301693","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}
L. Safdarian, A. Aleyasin, M. Aghahoseini, Parvaneh Lak, Sedigheh Hoseini Mosa, F. Sarvi, A. Mahdavi, Aida Najafian, Parvin Falahi, S. Khazaei
Objectives: The aim of the present study was to evaluate the effect of the intrauterine administration of platelet-rich plasma (PRP) before embryo transfer (ET) on pregnancy outcomes in women with repeated implantation failure (RIF). Materials and Methods: This randomized controlled trial included 120 RIF women who were candidates for frozen-thawed ET. In the PRP group (n=60), the intrauterine infusion of 0.5 mL PRP was performed 48 hours before ET, and the control group (n=60) underwent ET without intrauterine administration. Results: The implantation rate (28% vs. 11.9%, P<0.001), clinical pregnancy (51.6% vs. 26.6%, P=0.005), and live birth rate (58.3% vs. 28.3%, P=0.001) in PRP group were significantly higher compared to the control group. Based on the results, there was no significant difference with regard to miscarriage (12.5% vs. 12.9%, P=0.97) and multiple pregnancy rate (0.133% vs. 0.05%, P=0.11) between the two groups. Finally, preterm delivery was significantly higher in the PRP group (P<0.001). Conclusions: According to this study, the result revealed that PRP is effective in the improvement of pregnancy outcomes in RIF patients. Further studies are needed to identify the group of patients who would benefit from this intervention.
目的:本研究的目的是评估胚胎移植(ET)前宫内给予富血小板血浆(PRP)对反复着床失败(RIF)妇女妊娠结局的影响。材料与方法:本随机对照试验纳入120例冷冻解冻ET候选者的RIF妇女。PRP组(n=60)在ET前48小时宫内输注0.5 mL PRP,对照组(n=60)行ET,不宫内给药。结果:PRP组着床率(28% vs. 11.9%, P<0.001)、临床妊娠率(51.6% vs. 26.6%, P=0.005)、活产率(58.3% vs. 28.3%, P=0.001)显著高于对照组。结果显示,两组流产率(12.5%比12.9%,P=0.97)、多胎妊娠率(0.133%比0.05%,P=0.11)差异无统计学意义。最后,PRP组的早产率显著高于对照组(P<0.001)。结论:本研究结果显示PRP可有效改善RIF患者妊娠结局。需要进一步的研究来确定从这种干预中受益的患者群体。
{"title":"Efficacy of the Intrauterine Infusion of Platelet-Rich Plasma on Pregnancy Outcomes in Patients With Repeated Implantation Failure: A Randomized Control Trial","authors":"L. Safdarian, A. Aleyasin, M. Aghahoseini, Parvaneh Lak, Sedigheh Hoseini Mosa, F. Sarvi, A. Mahdavi, Aida Najafian, Parvin Falahi, S. Khazaei","doi":"10.15296/ijwhr.2022.08","DOIUrl":"https://doi.org/10.15296/ijwhr.2022.08","url":null,"abstract":"Objectives: The aim of the present study was to evaluate the effect of the intrauterine administration of platelet-rich plasma (PRP) before embryo transfer (ET) on pregnancy outcomes in women with repeated implantation failure (RIF). Materials and Methods: This randomized controlled trial included 120 RIF women who were candidates for frozen-thawed ET. In the PRP group (n=60), the intrauterine infusion of 0.5 mL PRP was performed 48 hours before ET, and the control group (n=60) underwent ET without intrauterine administration. Results: The implantation rate (28% vs. 11.9%, P<0.001), clinical pregnancy (51.6% vs. 26.6%, P=0.005), and live birth rate (58.3% vs. 28.3%, P=0.001) in PRP group were significantly higher compared to the control group. Based on the results, there was no significant difference with regard to miscarriage (12.5% vs. 12.9%, P=0.97) and multiple pregnancy rate (0.133% vs. 0.05%, P=0.11) between the two groups. Finally, preterm delivery was significantly higher in the PRP group (P<0.001). Conclusions: According to this study, the result revealed that PRP is effective in the improvement of pregnancy outcomes in RIF patients. Further studies are needed to identify the group of patients who would benefit from this intervention.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2020-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82887806","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}
R. Dargahi, Zahra Bahrami-asl, A. Dorosti, F. Mallah
Objectives: The coronavirus disease 2019 (COVID-19) pandemic increased the severity of the psychological problems of pregnant women, which can have severe consequences. The current study aimed to investigate the effects of COVID-19 on the stress, anxiety, depression, self-care behaviors, and the quality of the life of women at the risk of preterm labor. Materials and Methods: The current descriptive-analytical study was conducted from March 20, 2020 to June 21, 2020. In total, 88 women who were at risk of preterm labor in Tabriz (Iran) participated in this study. The association between the Depression, Anxiety and Stress Scale-21 Items (DASS-21) questionnaire, Hart’s self-care behaviors during pregnancy, and SF-36 (for the quality of life) were investigated using Pearson and Spearman correlations in SPSS 20 at P<0.05. Results: Based on the results of the Pearson correlation test, stress and self-care scores (P=0.003, r=-482), self-care and depression scores (P=0.006, r=-396), as well as anxiety and self-care scores (P=0.001, r=-511) had significant inverse linear correlations. According to the regression model, only the stress variable had a significant association with self-care (P=0.039). There was a positive and significant (P<0.05) correlation between self-care behaviors and three dimensions of marital quality including physical function, mental function, and the feeling of pain and discomfort. Conclusions: The results of the current study showed the significant inverse association between self-care and depression and stress and anxiety during pregnancy in women at risk of preterm labor during the COVID-19 pandemic. Low quality self-care behaviors also led to a decrease in the quality of life of these women.
{"title":"Investigating the Effects of COVID-19 Pandemic on Stress, Anxiety, Depression, Self-care Behaviors, and the Quality of Life of Women at Risk of Preterm Labor","authors":"R. Dargahi, Zahra Bahrami-asl, A. Dorosti, F. Mallah","doi":"10.15296/ijwhr.2022.09","DOIUrl":"https://doi.org/10.15296/ijwhr.2022.09","url":null,"abstract":"Objectives: The coronavirus disease 2019 (COVID-19) pandemic increased the severity of the psychological problems of pregnant women, which can have severe consequences. The current study aimed to investigate the effects of COVID-19 on the stress, anxiety, depression, self-care behaviors, and the quality of the life of women at the risk of preterm labor. Materials and Methods: The current descriptive-analytical study was conducted from March 20, 2020 to June 21, 2020. In total, 88 women who were at risk of preterm labor in Tabriz (Iran) participated in this study. The association between the Depression, Anxiety and Stress Scale-21 Items (DASS-21) questionnaire, Hart’s self-care behaviors during pregnancy, and SF-36 (for the quality of life) were investigated using Pearson and Spearman correlations in SPSS 20 at P<0.05. Results: Based on the results of the Pearson correlation test, stress and self-care scores (P=0.003, r=-482), self-care and depression scores (P=0.006, r=-396), as well as anxiety and self-care scores (P=0.001, r=-511) had significant inverse linear correlations. According to the regression model, only the stress variable had a significant association with self-care (P=0.039). There was a positive and significant (P<0.05) correlation between self-care behaviors and three dimensions of marital quality including physical function, mental function, and the feeling of pain and discomfort. Conclusions: The results of the current study showed the significant inverse association between self-care and depression and stress and anxiety during pregnancy in women at risk of preterm labor during the COVID-19 pandemic. Low quality self-care behaviors also led to a decrease in the quality of life of these women.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2020-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82505487","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}