Pub Date : 2024-11-06DOI: 10.3760/cma.j.cn112150-20240805-00625
Y Zong
Autoimmune gastritis (AIG) is a special type of atrophic gastritis caused by autoimmune abnormalities. Diagnosis of AIG is often delayed because of the absence of typical symptoms in the early stage, which results in inadequate treatment and poor cancer screening. It is crucial to improve the awareness of this disease. This article summarizes the clinical manifestations, endoscopic features, and treatments of autoimmune gastritis. Conventional therapy consists of adequate iron and vitamin B12 supplementation as well as symptomatic approaches. The associated risk for gastric adenocarcinoma and gastric neuroendocrine tumors requires regular endoscopic follow up. This article is helpful in prevention and treatment of AIG.
{"title":"[Update on diagnosis and treatment in autoimmune gastritis].","authors":"Y Zong","doi":"10.3760/cma.j.cn112150-20240805-00625","DOIUrl":"https://doi.org/10.3760/cma.j.cn112150-20240805-00625","url":null,"abstract":"<p><p>Autoimmune gastritis (AIG) is a special type of atrophic gastritis caused by autoimmune abnormalities. Diagnosis of AIG is often delayed because of the absence of typical symptoms in the early stage, which results in inadequate treatment and poor cancer screening. It is crucial to improve the awareness of this disease. This article summarizes the clinical manifestations, endoscopic features, and treatments of autoimmune gastritis. Conventional therapy consists of adequate iron and vitamin B12 supplementation as well as symptomatic approaches. The associated risk for gastric adenocarcinoma and gastric neuroendocrine tumors requires regular endoscopic follow up. This article is helpful in prevention and treatment of AIG.</p>","PeriodicalId":24033,"journal":{"name":"中华预防医学杂志","volume":"58 11","pages":"1752-1757"},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629746","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}
Pub Date : 2024-11-06DOI: 10.3760/cma.j.cn112150-20231219-00462
J Q Zhan, L L Song, Y Lin, Y Dong, Y Wang, W Chu
<p><p><b>Objective:</b> To investigate and analyze the correlation between the expression levels of CD38, HLA-DR and programmed cell death-1 (PD-1) on peripheral blood CD8<sup>+</sup>T cells and HIV-1 RNA viral load, immune activation and exhaustion in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). <b>Methods:</b> A total of 81 HIV/AIDS patients (64 without antiretroviral therapy and 17 with therapy) and 40 healthy donors in the same period were enrolled as the control group. Flow cytometry was used to analyze the CD4<sup>+</sup>T lymphocyte count and the expression levels of activation markers CD38 and HLA-DR and apoptosis marker PD-1 on CD8<sup>+</sup>T cells. HIV-1 RNA in the plasma of HIV-1 infected patients was quantitatively detected by real-time fluorescence quantitative polymerase chain reaction. Variance analysis was used to compare the expression levels of CD38, HLA-DR and PD-1 on CD8<sup>+</sup>T cells between HIV/AIDS patients and healthy controls. Spearman correlation analysis was used to analyze the correlation between different T lymphocyte counts and HIV RNA viral load, and the correlation between HIV RNA viral load and peripheral blood CD8<sup>+</sup>T cell CD38, HLA-DR and PD-1. <b>Results:</b> Among the 81 HIV/AIDS patients, 69 (85.19%) were males and 12 (14.81%) were females, with an age <i>M</i> (<i>Q</i><sub>1</sub><i>, Q</i><sub>3</sub>) of 58 (36.5, 65.0) years. There were 60 HIV/AIDS patients over 55 years old (74.07%) and 21 HIV/AIDS patients between 18 and 55 years old (25.93%). The results of variance analysis showed that compared with the healthy control group, the expression levels of CD38, HLA-DR and PD-1 on CD8<sup>+</sup>T cells in HIV/AIDS patients increased, and the differences were statistically significant (all <i>P</i><0.05). In addition, the expression of CD38, HLA-DR and PD-1 increased significantly in patients with CD4<sup>+</sup>T cell count less than 350 cells/μl, and the differences were statistically significant (all <i>P</i><0.05). Spearman correlation analysis showed that CD4<sup>+</sup>and CD4<sup>+</sup>/CD8<sup>+</sup>were negatively correlated with viral load in HIV/AIDS patients (<i>r</i>=-0.407 and -0.378, respectively, both <i>P</i><0.05), and CD8<sup>+</sup>was positively correlated with viral load (<i>r</i>=0.356, <i>P</i><0.05). When the HIV RNA level was≤10<sup>5</sup> CPs/ml, there was no correlation between the HIV RNA level and the expression levels of CD38, HLA-DR and PD-1 on CD8<sup>+</sup>T cells (all <i>P</i>>0.05). However, when the level of HIV RNA was>10<sup>5</sup> CPs/ml, the level of HIV RNA was positively correlated with the expression levels of CD38, HLA-DR and PD-1 on CD8<sup>+</sup>T cells (<i>r</i>=0.412, 0.387, 0.395, respectively, all <i>P</i><0.05). <b>Conclusions:</b> The activation levels of CD38 and HLA-DR and the expression of PD-1 on CD8<sup>+</sup>T cells in the peripheral blood of HIV/AIDS patients are increased. When
{"title":"[Study on the correlation between viral load and activation and exhaustion levels of CD8<sup>+</sup>T cells in HIV/AIDS patients].","authors":"J Q Zhan, L L Song, Y Lin, Y Dong, Y Wang, W Chu","doi":"10.3760/cma.j.cn112150-20231219-00462","DOIUrl":"https://doi.org/10.3760/cma.j.cn112150-20231219-00462","url":null,"abstract":"<p><p><b>Objective:</b> To investigate and analyze the correlation between the expression levels of CD38, HLA-DR and programmed cell death-1 (PD-1) on peripheral blood CD8<sup>+</sup>T cells and HIV-1 RNA viral load, immune activation and exhaustion in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). <b>Methods:</b> A total of 81 HIV/AIDS patients (64 without antiretroviral therapy and 17 with therapy) and 40 healthy donors in the same period were enrolled as the control group. Flow cytometry was used to analyze the CD4<sup>+</sup>T lymphocyte count and the expression levels of activation markers CD38 and HLA-DR and apoptosis marker PD-1 on CD8<sup>+</sup>T cells. HIV-1 RNA in the plasma of HIV-1 infected patients was quantitatively detected by real-time fluorescence quantitative polymerase chain reaction. Variance analysis was used to compare the expression levels of CD38, HLA-DR and PD-1 on CD8<sup>+</sup>T cells between HIV/AIDS patients and healthy controls. Spearman correlation analysis was used to analyze the correlation between different T lymphocyte counts and HIV RNA viral load, and the correlation between HIV RNA viral load and peripheral blood CD8<sup>+</sup>T cell CD38, HLA-DR and PD-1. <b>Results:</b> Among the 81 HIV/AIDS patients, 69 (85.19%) were males and 12 (14.81%) were females, with an age <i>M</i> (<i>Q</i><sub>1</sub><i>, Q</i><sub>3</sub>) of 58 (36.5, 65.0) years. There were 60 HIV/AIDS patients over 55 years old (74.07%) and 21 HIV/AIDS patients between 18 and 55 years old (25.93%). The results of variance analysis showed that compared with the healthy control group, the expression levels of CD38, HLA-DR and PD-1 on CD8<sup>+</sup>T cells in HIV/AIDS patients increased, and the differences were statistically significant (all <i>P</i><0.05). In addition, the expression of CD38, HLA-DR and PD-1 increased significantly in patients with CD4<sup>+</sup>T cell count less than 350 cells/μl, and the differences were statistically significant (all <i>P</i><0.05). Spearman correlation analysis showed that CD4<sup>+</sup>and CD4<sup>+</sup>/CD8<sup>+</sup>were negatively correlated with viral load in HIV/AIDS patients (<i>r</i>=-0.407 and -0.378, respectively, both <i>P</i><0.05), and CD8<sup>+</sup>was positively correlated with viral load (<i>r</i>=0.356, <i>P</i><0.05). When the HIV RNA level was≤10<sup>5</sup> CPs/ml, there was no correlation between the HIV RNA level and the expression levels of CD38, HLA-DR and PD-1 on CD8<sup>+</sup>T cells (all <i>P</i>>0.05). However, when the level of HIV RNA was>10<sup>5</sup> CPs/ml, the level of HIV RNA was positively correlated with the expression levels of CD38, HLA-DR and PD-1 on CD8<sup>+</sup>T cells (<i>r</i>=0.412, 0.387, 0.395, respectively, all <i>P</i><0.05). <b>Conclusions:</b> The activation levels of CD38 and HLA-DR and the expression of PD-1 on CD8<sup>+</sup>T cells in the peripheral blood of HIV/AIDS patients are increased. When","PeriodicalId":24033,"journal":{"name":"中华预防医学杂志","volume":"58 11","pages":"1690-1696"},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629708","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}
Pub Date : 2024-11-06DOI: 10.3760/cma.j.cn112150-20240102-00003
H Wang, J C Li, C G Bo, L Wang, Q Y Zhao, L M Zhu
Information on patients with rifampicin-resistant pulmonary tuberculosis (RR-PTB) in Yangzhou City from 2012 to 2020 was obtained from the Information System of the Chinese Center for Disease Control and Prevention. The epidemic characteristics of RR-PTB patients were analyzed by using χ2 test. The average annual registered incidence rate of RR-PTB patients in Yangzhou City from 2012 to 2020 was 0.57/100 000, and the difference between the registered incidence rates in each year was statistically significant (χ2=29.326, P<0.001). The proportion of re-treated patients (64.8%) was higher than that of newly treated patients (35.2%, χ2=50.593, P<0.001). The registered incidence rate in males (0.91/100 000) was higher than that in females (0.24/100 000, χ2=80.566, P<0.001). The age distribution showed that the highest incidence rate was in the age group≥60 years (0.96/100 000) and the lowest was in the age group 0-<45 years (0.31/100 000, χ2=55.853, P<0.001). From 2012 to 2020, Baoying County had the largest number of registered RR-PTB patients (44 cases), and its registered incidence rate (0.64/100 000) was only lower than that of Guangling District (0.98/100 000). The registered incidence rate of RR-PTB patients in Baoying County during 2016-2020 also increased significantly compared to 2012-2015 (P=0.001). Logistic regression was used to analyze the factors related to the treatment outcome of RR-PTB patients. The results showed that patients aged≥60 years and those classified as the re-treatment were risk factors for successful treatment of RR-PTB patients (P<0.05). In summary, males, people aged≥60 years, patients classified as the re-treatment, and residents of Baoying County should be the key populations for RR-PTB epidemic prevention and control in Yangzhou City.
{"title":"[Analysis of the epidemic characteristics and treatment outcomes of rifampicin-resistant pulmonary tuberculosis in Yangzhou City from 2012 to 2020].","authors":"H Wang, J C Li, C G Bo, L Wang, Q Y Zhao, L M Zhu","doi":"10.3760/cma.j.cn112150-20240102-00003","DOIUrl":"https://doi.org/10.3760/cma.j.cn112150-20240102-00003","url":null,"abstract":"<p><p>Information on patients with rifampicin-resistant pulmonary tuberculosis (RR-PTB) in Yangzhou City from 2012 to 2020 was obtained from the Information System of the Chinese Center for Disease Control and Prevention. The epidemic characteristics of RR-PTB patients were analyzed by using <i>χ</i><sup>2</sup> test. The average annual registered incidence rate of RR-PTB patients in Yangzhou City from 2012 to 2020 was 0.57/100 000, and the difference between the registered incidence rates in each year was statistically significant (<i>χ</i><sup>2</sup>=29.326, <i>P</i><0.001). The proportion of re-treated patients (64.8%) was higher than that of newly treated patients (35.2%, <i>χ</i><sup>2</sup>=50.593, <i>P</i><0.001). The registered incidence rate in males (0.91/100 000) was higher than that in females (0.24/100 000, <i>χ</i><sup>2</sup>=80.566, <i>P</i><0.001). The age distribution showed that the highest incidence rate was in the age group≥60 years (0.96/100 000) and the lowest was in the age group 0-<45 years (0.31/100 000, <i>χ</i><sup>2</sup>=55.853, <i>P</i><0.001). From 2012 to 2020, Baoying County had the largest number of registered RR-PTB patients (44 cases), and its registered incidence rate (0.64/100 000) was only lower than that of Guangling District (0.98/100 000). The registered incidence rate of RR-PTB patients in Baoying County during 2016-2020 also increased significantly compared to 2012-2015 (<i>P</i>=0.001). Logistic regression was used to analyze the factors related to the treatment outcome of RR-PTB patients. The results showed that patients aged≥60 years and those classified as the re-treatment were risk factors for successful treatment of RR-PTB patients (<i>P</i><0.05). In summary, males, people aged≥60 years, patients classified as the re-treatment, and residents of Baoying County should be the key populations for RR-PTB epidemic prevention and control in Yangzhou City.</p>","PeriodicalId":24033,"journal":{"name":"中华预防医学杂志","volume":"58 11","pages":"1679-1683"},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629622","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}
Pub Date : 2024-11-06DOI: 10.3760/cma.j.cn112150-20240620-00486
T T Hu, X Y Jiang, M Guan
<p><p>To investigate the degrees of EB virus reactivation in patients with inflammatory bowel disease (IBD) treated with different biologics and the levels of important cytokines associated with relapse under the influence of this virus, and to assess its diagnostic efficacy as a risk factor for identifying disease relapse. A case-control retrospective study based on patients' hospitalization history data was conducted to select a total of 105 patients who were hospitalized in the Department of Gastroenterology, Huashan Hospital, Fudan University, with a confirmed diagnosis of IBD from 2021 to 2023. Based on the quantitative copy level of whole blood EBV DNA to determine the status of EB virus infection in patients, integrated cytokine 8 (IL-2, IL-4, IL-6, IL-10, IL-12p70, IL-17, TNF-α, IFN-γ), C-reactive protein, and fecal calreticulin, to find the risk variable associated with treatment relapse. Logistic regression was used to analyze the relative risk between this variable and treatment relapse, and ROC curves were used to predict the diagnostic efficacy of cytokine multifactorial thresholds for treatment relapse. Results showed that the median age of the study was 37(26, 54)years, with a minimum of 18 years and a maximum of 70 years, with a median age of 34(24, 51) years for Crohn's Disease (CD) patients and 46(35, 60) years for Ulcerative colitis (UC) patients, with a statistically difference between the ages of the two groups (<i>t</i>=2.675, <i>P</i>=0.009). The median age at 50 years of patients treated with Vedolizumab (VDZ) in the UC group was higher than in the treatment groups other than VDZ. The highest rate of EB virusreactivation was found in the group treated with immunosuppressants Azathioprine (AZA) combined with anti-tumor necrosis factor-α (anti-TNF-α) and VDZ (62.5% in both groups), and the lowest in the group treated with Ustekinumab (UST) (0%). IL-2 levels were elevated in the AZA+anti-TNF-α and anti-TNF-α groups after EB virus entryreactivation. Three treatment groups, AZA+anti-TNF-α, anti-TNF-α, and VDZ, had elevated levels of IL-6 expression after EB virus entry reactivation.In the anti-TNF-α treatment-related group IL-2was associated with treatment relapse in IBD (<i>OR</i>=1.127, 95%<i>CI:</i> 1.044-1.256, <i>P</i>=0.007). ROC analysis showed that the AUC for IL-2 combined with EB virus in a replicative state was 0.8282 (<i>P</i>=0.006), with a negative predictive value and a positive value of 90% and 75%, respectively. As well as IL-6 was associated with treatment relapse of IBD in the anti-TNF-αtreatment-related group as well as in the VDZ-treated group (<i>OR</i>=1.049, 95%<i>CI:</i> 1.017-1.095, <i>P</i>=0.008). ROC analysis showed that the diagnostic sensitivity and specificity for post-treatment relapse at a critical value of 6.10 pg/ml for IL-6 was 83.33% and 82.93%, respectively. The AUC for IL-6 combined with EB virus in a replicative state was 0.900 (<i>P</i><0.000 1), with negative and positive predictive va
{"title":"[Analysis of clinical characteristics and risk factors for recurrence of combined EB virus infection in patients with inflammatory bowel disease treated with biological agents].","authors":"T T Hu, X Y Jiang, M Guan","doi":"10.3760/cma.j.cn112150-20240620-00486","DOIUrl":"https://doi.org/10.3760/cma.j.cn112150-20240620-00486","url":null,"abstract":"<p><p>To investigate the degrees of EB virus reactivation in patients with inflammatory bowel disease (IBD) treated with different biologics and the levels of important cytokines associated with relapse under the influence of this virus, and to assess its diagnostic efficacy as a risk factor for identifying disease relapse. A case-control retrospective study based on patients' hospitalization history data was conducted to select a total of 105 patients who were hospitalized in the Department of Gastroenterology, Huashan Hospital, Fudan University, with a confirmed diagnosis of IBD from 2021 to 2023. Based on the quantitative copy level of whole blood EBV DNA to determine the status of EB virus infection in patients, integrated cytokine 8 (IL-2, IL-4, IL-6, IL-10, IL-12p70, IL-17, TNF-α, IFN-γ), C-reactive protein, and fecal calreticulin, to find the risk variable associated with treatment relapse. Logistic regression was used to analyze the relative risk between this variable and treatment relapse, and ROC curves were used to predict the diagnostic efficacy of cytokine multifactorial thresholds for treatment relapse. Results showed that the median age of the study was 37(26, 54)years, with a minimum of 18 years and a maximum of 70 years, with a median age of 34(24, 51) years for Crohn's Disease (CD) patients and 46(35, 60) years for Ulcerative colitis (UC) patients, with a statistically difference between the ages of the two groups (<i>t</i>=2.675, <i>P</i>=0.009). The median age at 50 years of patients treated with Vedolizumab (VDZ) in the UC group was higher than in the treatment groups other than VDZ. The highest rate of EB virusreactivation was found in the group treated with immunosuppressants Azathioprine (AZA) combined with anti-tumor necrosis factor-α (anti-TNF-α) and VDZ (62.5% in both groups), and the lowest in the group treated with Ustekinumab (UST) (0%). IL-2 levels were elevated in the AZA+anti-TNF-α and anti-TNF-α groups after EB virus entryreactivation. Three treatment groups, AZA+anti-TNF-α, anti-TNF-α, and VDZ, had elevated levels of IL-6 expression after EB virus entry reactivation.In the anti-TNF-α treatment-related group IL-2was associated with treatment relapse in IBD (<i>OR</i>=1.127, 95%<i>CI:</i> 1.044-1.256, <i>P</i>=0.007). ROC analysis showed that the AUC for IL-2 combined with EB virus in a replicative state was 0.8282 (<i>P</i>=0.006), with a negative predictive value and a positive value of 90% and 75%, respectively. As well as IL-6 was associated with treatment relapse of IBD in the anti-TNF-αtreatment-related group as well as in the VDZ-treated group (<i>OR</i>=1.049, 95%<i>CI:</i> 1.017-1.095, <i>P</i>=0.008). ROC analysis showed that the diagnostic sensitivity and specificity for post-treatment relapse at a critical value of 6.10 pg/ml for IL-6 was 83.33% and 82.93%, respectively. The AUC for IL-6 combined with EB virus in a replicative state was 0.900 (<i>P</i><0.000 1), with negative and positive predictive va","PeriodicalId":24033,"journal":{"name":"中华预防医学杂志","volume":"58 11","pages":"1711-1719"},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629613","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}
Pub Date : 2024-11-06DOI: 10.3760/cma.j.cn112150-20240503-00358
S Q Zhong, N N Li, M H Wang
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains an effective treatment for hematological malignancies. Cytomegalovirus (CMV) infection is one of the common Infection complications after hematopoietic stem cell transplantation, and also the main cause of death of transplant recipients, which has a significant impact on the prognosis and survival of transplant recipients. It is particularly important to take timely and effective prevention and treatment for CMV infected transplant patients. This article discusses the latest prevention and treatment of CMV infection after transplantation,and reviews the recent progress in the prevention and drug treatment of CMV infection in allo-HSCT patients by searching the relevant literature through Pubmed.
{"title":"[Progress in prevention and treatment of cytomegalovirus infection in patients with allogeneic hematopoietic stem cell transplantation].","authors":"S Q Zhong, N N Li, M H Wang","doi":"10.3760/cma.j.cn112150-20240503-00358","DOIUrl":"https://doi.org/10.3760/cma.j.cn112150-20240503-00358","url":null,"abstract":"<p><p>Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains an effective treatment for hematological malignancies. Cytomegalovirus (CMV) infection is one of the common Infection complications after hematopoietic stem cell transplantation, and also the main cause of death of transplant recipients, which has a significant impact on the prognosis and survival of transplant recipients. It is particularly important to take timely and effective prevention and treatment for CMV infected transplant patients. This article discusses the latest prevention and treatment of CMV infection after transplantation,and reviews the recent progress in the prevention and drug treatment of CMV infection in allo-HSCT patients by searching the relevant literature through Pubmed.</p>","PeriodicalId":24033,"journal":{"name":"中华预防医学杂志","volume":"58 11","pages":"1763-1770"},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629713","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}
Pub Date : 2024-10-06DOI: 10.3760/cma.j.cn112150-20231206-00407
H X Jia, L F Jiang, C L Wang, J N Zhang, Y N Wei, J F Lu, Y M Qiu, J J Zhao, B J Ma
Using big data and artificial intelligence to establish a multi-point monitoring, early warning, and disposal system to achieve early warning and intervention of infectious disease outbreaks is an important means of controlling the spread of the epidemic. Taking Xiaoshan district as an example, this study analyzes the monitoring contents, warning methods, and application effectiveness of the infectious disease monitoring, early warning and disposal system. Based on Xiaoshan's health big data resources, the system starts with syndrome, disease diagnosis and etiology. Through advanced technologies such as artificial intelligence and block chain, it realizes early identification of infectious disease outbreaks, data fusion, multi-cross collaboration, and closed-loop management. It has improved the sensitivity of clustered outbreaks monitoring and the effectiveness of epidemic disposal and provided a reference for grassroots disease prevention and control departments to establish an infectious disease monitoring and early warning system.
{"title":"[Establishment and application of infectious disease monitoring, early warning and disposal system].","authors":"H X Jia, L F Jiang, C L Wang, J N Zhang, Y N Wei, J F Lu, Y M Qiu, J J Zhao, B J Ma","doi":"10.3760/cma.j.cn112150-20231206-00407","DOIUrl":"https://doi.org/10.3760/cma.j.cn112150-20231206-00407","url":null,"abstract":"<p><p>Using big data and artificial intelligence to establish a multi-point monitoring, early warning, and disposal system to achieve early warning and intervention of infectious disease outbreaks is an important means of controlling the spread of the epidemic. Taking Xiaoshan district as an example, this study analyzes the monitoring contents, warning methods, and application effectiveness of the infectious disease monitoring, early warning and disposal system. Based on Xiaoshan's health big data resources, the system starts with syndrome, disease diagnosis and etiology. Through advanced technologies such as artificial intelligence and block chain, it realizes early identification of infectious disease outbreaks, data fusion, multi-cross collaboration, and closed-loop management. It has improved the sensitivity of clustered outbreaks monitoring and the effectiveness of epidemic disposal and provided a reference for grassroots disease prevention and control departments to establish an infectious disease monitoring and early warning system.</p>","PeriodicalId":24033,"journal":{"name":"中华预防医学杂志","volume":"58 10","pages":"1620-1624"},"PeriodicalIF":0.0,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476342","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}
Pub Date : 2024-10-06DOI: 10.3760/cma.j.cn112150-20240514-00386
H Huang, J Wei, H J Shen, Q X Tan, J Xue, C Wang
<p><p><b>Objective:</b> To investigate the changes of the distribution and drug resistance profile of bacteria from ICU children with lower respiratory tract infection (LRTI) in Suzhou City, Jiangsu Province from 2017 to 2022. <b>Methods:</b> From January 2017 to December 2022, a cross-sectional observational study on the bacterial spectrum analysis among intensive care unit (ICU) children with LRTI was conducted in Children's Hospital of Soochow University. The bacteria was cultivated by culture methods from sputum samples, and identified by MALDI-TOF mass spectrometry. Drug sensitivity tests were performed by the VITEK2 Compact fully automated analysis system and the paper slide method. The <i>χ</i><sup>2</sup> test or Fisher's exact probability was used to analyze the changes of the distribution of sputum culture-positive bacteria and drug resistance in ICU children. <b>Results:</b> The overall detection rate of sputum culture was 42.06% (1 182/2 810). <i>Staphylococcus aureus</i> (25.63%,303/1 182), <i>Acinetobacter baumannii</i> (13.62%,161/1 182) and <i>Haemaphilus influenzae</i> (13.28%,157/1 182) were the top three. Proportions of <i>Acinetobacter baumannii</i> (17.90% <i>vs.</i> 11.02%,<i>χ</i>²=11.17, <i>P</i>=0.001), especially carbapenem-resistant <i>Acinetobacter baumannii</i> (43.70% <i>vs.</i> 23.50%, <i>χ²</i>=15.21, <i>P</i><0.001) increased significantly from 2020 to 2022. However, the proportions of <i>Haemophilus influenzae</i> (8.50% <i>vs.</i> 16.19%, <i>χ</i>²=14.27, <i>P</i><0.001), <i>Streptococcus pneumoniae</i> (8.50% <i>vs.</i> 15.92%, <i>χ</i>²=13.42, <i>P</i><0.001) and extended-spectrum-lactamase producing <i>Escherichia coli</i> (8.89% <i>vs.</i> 18.00%, <i>χ</i>²=5.45, <i>P</i>=0.025) decreased. Drug resistant results showed that <i>Acinetobacter baumannii</i> was obviously more resistant to imipenem (<i>χ²</i>=4.43, <i>P</i>=0.035) and levofloxacin (<i>χ</i>²=12.53, <i>P</i><0.001), while more sensitive to minocycline (<i>χ</i>²=8.34, <i>P</i>=0.004). Escherichia coli showed a significant increase in resistance to piperacillin tazobactam (<i>χ</i>²=8.29, <i>P</i>=0.008) and cefoperazone sulbactam (<i>χ</i>²=5.07, <i>P</i>=0.024) from 2020 to 2022; Klebsiella pneumoniae consistently maintained a resistance rate of more than 60% to first and second-generation cephalosporins, and remain susceptible to quinolones and carbapenems. Staphylococcus aureus remained highly susceptible to levofloxacin (drug resistance rate: 2.31%,7/303) and sulfamethoxazole/trimethoprim (drug resistance rate: 4.95%,15/303) from 2020 to 2022. <b>Conclusion:</b> Higher detection and resistance rates of <i>Acinetobacter baumannii</i> from sputum culture in ICU children from 2020 to 2022 were explored. Resistance of <i>Escherichia coli</i> to β-lactamase inhibitor combinations was more serious. Regular monitoring the changes of the etiology of respiratory tract infections in ICU Children is particularly important for the prevention and treatmen
{"title":"[Analysis of the changes of bacterial spectrum and drug resistance in sputum culture of ICU children in a hospital of pediatric in Jiangsu Province from 2017 to 2022].","authors":"H Huang, J Wei, H J Shen, Q X Tan, J Xue, C Wang","doi":"10.3760/cma.j.cn112150-20240514-00386","DOIUrl":"https://doi.org/10.3760/cma.j.cn112150-20240514-00386","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the changes of the distribution and drug resistance profile of bacteria from ICU children with lower respiratory tract infection (LRTI) in Suzhou City, Jiangsu Province from 2017 to 2022. <b>Methods:</b> From January 2017 to December 2022, a cross-sectional observational study on the bacterial spectrum analysis among intensive care unit (ICU) children with LRTI was conducted in Children's Hospital of Soochow University. The bacteria was cultivated by culture methods from sputum samples, and identified by MALDI-TOF mass spectrometry. Drug sensitivity tests were performed by the VITEK2 Compact fully automated analysis system and the paper slide method. The <i>χ</i><sup>2</sup> test or Fisher's exact probability was used to analyze the changes of the distribution of sputum culture-positive bacteria and drug resistance in ICU children. <b>Results:</b> The overall detection rate of sputum culture was 42.06% (1 182/2 810). <i>Staphylococcus aureus</i> (25.63%,303/1 182), <i>Acinetobacter baumannii</i> (13.62%,161/1 182) and <i>Haemaphilus influenzae</i> (13.28%,157/1 182) were the top three. Proportions of <i>Acinetobacter baumannii</i> (17.90% <i>vs.</i> 11.02%,<i>χ</i>²=11.17, <i>P</i>=0.001), especially carbapenem-resistant <i>Acinetobacter baumannii</i> (43.70% <i>vs.</i> 23.50%, <i>χ²</i>=15.21, <i>P</i><0.001) increased significantly from 2020 to 2022. However, the proportions of <i>Haemophilus influenzae</i> (8.50% <i>vs.</i> 16.19%, <i>χ</i>²=14.27, <i>P</i><0.001), <i>Streptococcus pneumoniae</i> (8.50% <i>vs.</i> 15.92%, <i>χ</i>²=13.42, <i>P</i><0.001) and extended-spectrum-lactamase producing <i>Escherichia coli</i> (8.89% <i>vs.</i> 18.00%, <i>χ</i>²=5.45, <i>P</i>=0.025) decreased. Drug resistant results showed that <i>Acinetobacter baumannii</i> was obviously more resistant to imipenem (<i>χ²</i>=4.43, <i>P</i>=0.035) and levofloxacin (<i>χ</i>²=12.53, <i>P</i><0.001), while more sensitive to minocycline (<i>χ</i>²=8.34, <i>P</i>=0.004). Escherichia coli showed a significant increase in resistance to piperacillin tazobactam (<i>χ</i>²=8.29, <i>P</i>=0.008) and cefoperazone sulbactam (<i>χ</i>²=5.07, <i>P</i>=0.024) from 2020 to 2022; Klebsiella pneumoniae consistently maintained a resistance rate of more than 60% to first and second-generation cephalosporins, and remain susceptible to quinolones and carbapenems. Staphylococcus aureus remained highly susceptible to levofloxacin (drug resistance rate: 2.31%,7/303) and sulfamethoxazole/trimethoprim (drug resistance rate: 4.95%,15/303) from 2020 to 2022. <b>Conclusion:</b> Higher detection and resistance rates of <i>Acinetobacter baumannii</i> from sputum culture in ICU children from 2020 to 2022 were explored. Resistance of <i>Escherichia coli</i> to β-lactamase inhibitor combinations was more serious. Regular monitoring the changes of the etiology of respiratory tract infections in ICU Children is particularly important for the prevention and treatmen","PeriodicalId":24033,"journal":{"name":"中华预防医学杂志","volume":"58 10","pages":"1534-1540"},"PeriodicalIF":0.0,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476336","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}
Pub Date : 2024-10-06DOI: 10.3760/cma.j.cn112150-20240527-00430
M M Jia, Y L Cao, Y X Liu, L Zhang, J X Ma, L Z Feng
The innovation of integrating medical treatment and prevention mechanisms is a key task deployed by the government, aiming to promote the construction of a Healthy China and address the prevalent "treatment over prevention" mindset in healthcare services and society. Vaccination is an effective strategy for preventing and controlling infectious diseases; however, adult vaccination rates in China remain low due to insufficient awareness and enthusiasm among the public and healthcare professionals. In recent years, various regions have begun to explore the model of physicians in medical institutions prescribing vaccines to improve vaccination rates. This article analyzes the positioning, current implementation status, and challenges of vaccine prescriptions, and proposes recommendations advocating policy formulation, improving service models and supporting measures, improving funding mechanisms, and strengthening publicity and education to promote the widespread implementation and effectiveness of vaccine prescriptions.
{"title":"[Reflections on the positioning and implementation pathways of adult vaccine prescriptions].","authors":"M M Jia, Y L Cao, Y X Liu, L Zhang, J X Ma, L Z Feng","doi":"10.3760/cma.j.cn112150-20240527-00430","DOIUrl":"https://doi.org/10.3760/cma.j.cn112150-20240527-00430","url":null,"abstract":"<p><p>The innovation of integrating medical treatment and prevention mechanisms is a key task deployed by the government, aiming to promote the construction of a Healthy China and address the prevalent \"treatment over prevention\" mindset in healthcare services and society. Vaccination is an effective strategy for preventing and controlling infectious diseases; however, adult vaccination rates in China remain low due to insufficient awareness and enthusiasm among the public and healthcare professionals. In recent years, various regions have begun to explore the model of physicians in medical institutions prescribing vaccines to improve vaccination rates. This article analyzes the positioning, current implementation status, and challenges of vaccine prescriptions, and proposes recommendations advocating policy formulation, improving service models and supporting measures, improving funding mechanisms, and strengthening publicity and education to promote the widespread implementation and effectiveness of vaccine prescriptions.</p>","PeriodicalId":24033,"journal":{"name":"中华预防医学杂志","volume":"58 10","pages":"1616-1619"},"PeriodicalIF":0.0,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476349","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}
Pub Date : 2024-10-06DOI: 10.3760/cma.j.cn112150-20240708-00546
X N Zhang, Q T Meng, H W Zhang, C Wang, S Y Zhang, H Q Chen, X B Li, R Chen
<p><p><b>Objective:</b> To investigate the effect and potential mechanism of exposure to 20 nm polystyrene nanoplastics (PS-NPs) on lipid metabolism in mice liver. <b>Methods:</b> An animal experimental model was designed, which was completed from September 2022 to July 2023 on the exposure omics platform of the School of Public Health at Capital Medical University and the Key Laboratory of Environment and Population Health at the Chinese Center for Disease Control and Prevention.1 mg/kg and 10 mg/kg PS-NPs tail vein mice exposure models were constructed. After exposure 7 d, serum was collected to measure the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) and air flow assisted desorption electrospray ionization-mass spectrometry imaging (AFADESI-MSI) analysis were used to analyze the mRNA levels of fatty acid esterification related genes (<i>Dgat1</i> and <i>Dgat2</i>) and lipid transport related genes (<i>ApoB</i>, <i>Cd36</i>, <i>ApoE</i> and <i>Mttp</i>) and metabolites' spatial changes in liver tissue. <i>In vivo</i> imaging system (IVIS) and tissue shake sections were employed to observe the fluorescence biological distribution of PS-NPs. <i>t</i>-test or one-way ANOVA was used to explore the difference between groups. <b>Results:</b> The serum ALT levels were (83.97±4.58), (91.17±13.69) and (142.43±6.09) U/L in the control group, 1 mg/kg PS-NPs exposure group and 10 mg/kg PS-NPs exposure group respectively (<i>F</i>=37.281, <i>P</i><0.05). The relative mRNA levels of <i>Dgat1</i>, <i>Dgat2</i>, <i>ApoB</i>, <i>Cd36</i> and <i>ApoE</i> were (1.49±0.63, 2.53±0.32, 2.45±0.54), (1.07±0.38, 1.86±0.83, 2.23±0.73), (1.01±0.13, 1.58±0.43, 2.03±0.52), (1.01±0.14, 1.55±0.37, 1.52±0.51), (1.01±0.17, 2.11±0.27, 2.39±0.93) in these three groups respectively. The differences were statistically significant (<i>F</i>=11.54, 6.95, 14.90, 5.98 and 14.68, <i>P</i><0.05). AFADESI-MSI analysis found that PS-NPs exposure led to a significant decrease in the levels of glutarylcarnitine and O-Linoleoylcarnitine (<i>t</i>=4.12 and 3.35, <i>P</i><0.05), which were associated with lipid beta oxidation. The content of triglycerides (TG) (m/z 921.726 4, <i>t</i>=8.69, <i>P</i><0.05; m/z 919.711 4, <i>t</i>=3.20, <i>P</i><0.05), phosphatidylic acid (PA) (m/z 895.712 3, <i>t</i>=3.60, <i>P</i><0.05; m/z 821.526 6, <i>t</i>=3.36, <i>P</i><0.05), lysophosphatidylcholine (LysoPC) (m/z 560.310 6, <i>t</i>=3.35, <i>P</i><0.05; m/z 582.295 3, <i>t</i>=6.28, <i>P</i><0.05), phosphatidylcholine (PC) (m/z 778.533 9, <i>t</i>=3.53, <i>P</i><0.05; m/z 804.549 6, <i>t</i>=3.60, <i>P</i><0.05; m/z 820.523 1, <i>t</i>=3.37, <i>P</i><0.05), phosphatidylethanolamine (PE) (m/z 772.523 3, <i>t</i>=3.08, <i>P</i><0.05) showed a significant increase in the PS-NPs exposure group. <i>In vivo</i> and <i>in vitro</i> imaging and in situ cell localization revealed that PS-NPs were mai
{"title":"[The effect and mechanism of exposure to polystyrene nanoplastics on lipid metabolism in mice liver].","authors":"X N Zhang, Q T Meng, H W Zhang, C Wang, S Y Zhang, H Q Chen, X B Li, R Chen","doi":"10.3760/cma.j.cn112150-20240708-00546","DOIUrl":"https://doi.org/10.3760/cma.j.cn112150-20240708-00546","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the effect and potential mechanism of exposure to 20 nm polystyrene nanoplastics (PS-NPs) on lipid metabolism in mice liver. <b>Methods:</b> An animal experimental model was designed, which was completed from September 2022 to July 2023 on the exposure omics platform of the School of Public Health at Capital Medical University and the Key Laboratory of Environment and Population Health at the Chinese Center for Disease Control and Prevention.1 mg/kg and 10 mg/kg PS-NPs tail vein mice exposure models were constructed. After exposure 7 d, serum was collected to measure the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) and air flow assisted desorption electrospray ionization-mass spectrometry imaging (AFADESI-MSI) analysis were used to analyze the mRNA levels of fatty acid esterification related genes (<i>Dgat1</i> and <i>Dgat2</i>) and lipid transport related genes (<i>ApoB</i>, <i>Cd36</i>, <i>ApoE</i> and <i>Mttp</i>) and metabolites' spatial changes in liver tissue. <i>In vivo</i> imaging system (IVIS) and tissue shake sections were employed to observe the fluorescence biological distribution of PS-NPs. <i>t</i>-test or one-way ANOVA was used to explore the difference between groups. <b>Results:</b> The serum ALT levels were (83.97±4.58), (91.17±13.69) and (142.43±6.09) U/L in the control group, 1 mg/kg PS-NPs exposure group and 10 mg/kg PS-NPs exposure group respectively (<i>F</i>=37.281, <i>P</i><0.05). The relative mRNA levels of <i>Dgat1</i>, <i>Dgat2</i>, <i>ApoB</i>, <i>Cd36</i> and <i>ApoE</i> were (1.49±0.63, 2.53±0.32, 2.45±0.54), (1.07±0.38, 1.86±0.83, 2.23±0.73), (1.01±0.13, 1.58±0.43, 2.03±0.52), (1.01±0.14, 1.55±0.37, 1.52±0.51), (1.01±0.17, 2.11±0.27, 2.39±0.93) in these three groups respectively. The differences were statistically significant (<i>F</i>=11.54, 6.95, 14.90, 5.98 and 14.68, <i>P</i><0.05). AFADESI-MSI analysis found that PS-NPs exposure led to a significant decrease in the levels of glutarylcarnitine and O-Linoleoylcarnitine (<i>t</i>=4.12 and 3.35, <i>P</i><0.05), which were associated with lipid beta oxidation. The content of triglycerides (TG) (m/z 921.726 4, <i>t</i>=8.69, <i>P</i><0.05; m/z 919.711 4, <i>t</i>=3.20, <i>P</i><0.05), phosphatidylic acid (PA) (m/z 895.712 3, <i>t</i>=3.60, <i>P</i><0.05; m/z 821.526 6, <i>t</i>=3.36, <i>P</i><0.05), lysophosphatidylcholine (LysoPC) (m/z 560.310 6, <i>t</i>=3.35, <i>P</i><0.05; m/z 582.295 3, <i>t</i>=6.28, <i>P</i><0.05), phosphatidylcholine (PC) (m/z 778.533 9, <i>t</i>=3.53, <i>P</i><0.05; m/z 804.549 6, <i>t</i>=3.60, <i>P</i><0.05; m/z 820.523 1, <i>t</i>=3.37, <i>P</i><0.05), phosphatidylethanolamine (PE) (m/z 772.523 3, <i>t</i>=3.08, <i>P</i><0.05) showed a significant increase in the PS-NPs exposure group. <i>In vivo</i> and <i>in vitro</i> imaging and in situ cell localization revealed that PS-NPs were mai","PeriodicalId":24033,"journal":{"name":"中华预防医学杂志","volume":"58 10","pages":"1524-1533"},"PeriodicalIF":0.0,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476360","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}
Pub Date : 2024-10-06DOI: 10.3760/cma.j.cn112150-20231202-00393
Ranyila Wumaier, Q G Ren, P H Liao, Aiyireti Maimaiti, S L Wang, X Y Hu, L Zhang, Fuerhati Wushouer
The study used the Delphi method to conduct two rounds of expert consultations involving 23 experts nationwide, aiming to establish the comprehensive index system for field epidemiological investigations of viral respiratory infectious diseases and determine the weights assigned to each index through the hierarchical analysis. Both rounds of consultation witnessed a 100% participation rate among all experts, with a coefficient of authority (Cr) reaching 0.89. The Kendall's W coefficients for assessing the importance and feasibility in both rounds were 0.108, 0.234, 0.439 and 0.427, respectively. Finally, an index system consisting of seven first-level indicators, 18 second-level indicators, and 36 third-level indicators was constructed for the technical guidelines governing field epidemiological investigations into viral respiratory infectious diseases, and the weight of each indicator was established. The index system constructed in this study has a high degree of scientificity, reliability and operability, but it still needs to be further adjusted and improved in combination with the epidemiological characteristics of viral respiratory infectious diseases.
{"title":"[Study on the index system for field epidemiological investigations of viral respiratory infectious diseases].","authors":"Ranyila Wumaier, Q G Ren, P H Liao, Aiyireti Maimaiti, S L Wang, X Y Hu, L Zhang, Fuerhati Wushouer","doi":"10.3760/cma.j.cn112150-20231202-00393","DOIUrl":"https://doi.org/10.3760/cma.j.cn112150-20231202-00393","url":null,"abstract":"<p><p>The study used the Delphi method to conduct two rounds of expert consultations involving 23 experts nationwide, aiming to establish the comprehensive index system for field epidemiological investigations of viral respiratory infectious diseases and determine the weights assigned to each index through the hierarchical analysis. Both rounds of consultation witnessed a 100% participation rate among all experts, with a coefficient of authority (Cr) reaching 0.89. The Kendall's W coefficients for assessing the importance and feasibility in both rounds were 0.108, 0.234, 0.439 and 0.427, respectively. Finally, an index system consisting of seven first-level indicators, 18 second-level indicators, and 36 third-level indicators was constructed for the technical guidelines governing field epidemiological investigations into viral respiratory infectious diseases, and the weight of each indicator was established. The index system constructed in this study has a high degree of scientificity, reliability and operability, but it still needs to be further adjusted and improved in combination with the epidemiological characteristics of viral respiratory infectious diseases.</p>","PeriodicalId":24033,"journal":{"name":"中华预防医学杂志","volume":"58 10","pages":"1562-1566"},"PeriodicalIF":0.0,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476351","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}
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