Objective: Eosinophilic esophagitis is a chronic inflammatory disease characterized by eosinophilic infiltration and esophagus dysfunction symptoms. Proton pump inhibitor responsive esophageal eosinophilia is similar to eosinophilic esophagitis in terms of clinical, laboratory, genetic expression profile, endoscopic and histopathological features. In this study, we aimed to share demographic features, clinical, laboratory and histopathological findings, and treatment outcomes of patient with eosinophilic esophagitis and proton pump inhibitor responsive esophageal eosinophilia. Materials and Methods: Demographic features, laboratory, endoscopic and histopathological findings, and treatment outcomes of patients followed in our clinic were recorded retrospectively since January 2010. Results: Four thousand six hundred fifty five patients underwent esophagogastroscopy since 2010 in our clinic and 0.4% (n=18) of these patients were diagnosed with eosinophilic esophagitis, and 0.2% (n=8) with proton pump inhibitor-responsive esophageal eosinophilia. The main symptom of patients with eosinophilic esophagitis were food impaction/dysphagia (n=5, 27.8%) and chronic abdominal pain (n=5, 27.8%). Allergen sensitization was found in 14 (77.8%), increased IgE in 12 (66.7%), peripheral eosinophilia in 12 (66.7%), and food allergen sensitization in 10 patients (55.6%) with eosinophilic esophagitis. On histopathological examination, the mean intraepithelial eosinophil count was 48.9 ± 30.9 cells / HPF (400x). When patients with eosinophilic esophagitis (group 1) and proton pump inhibitor-responsive esophageal eosinophilia (group 2) were compared, it was found that chronic abdominal pain was more common in the proton pump inhibitor-responsive esophageal eosinophilia group and food allergen sensitization in the eosinophilic esophagitis group (p<0.05). Total IgE, peripheral eosinophil count and intraepithelial eosinophil count were higher in the eosinophilic esophagitis group, but the differences were not statistically significant. Diet (n=11), medical (n=17) and dilatation (n=1) therapies were used in the eosinophilic esophagitis group. Fibrosis was detected on the histopathological examination in two patients who underwent TED and then SED was started. No side effect was seen any group in long term. Conclusion: Eosinophilic esophagitis and proton pump inhibitor-responsive esophageal eosinophilia have similar laboratory and histopathological features but eosinophilic esophagitis should be suspected more frequently in the presence of food allergy. Long-term followup is essential in patients with eosinophilic esophagitis.
{"title":"Eosinophilic Esophagitis and Proton Pump Inhibitor-Responsive Esophageal Eosinophilia; Single Center Experience","authors":"Elif Sağ, S. Mungan, F. Orhan, M. Çakır","doi":"10.21911/AAI.412","DOIUrl":"https://doi.org/10.21911/AAI.412","url":null,"abstract":"Objective: Eosinophilic esophagitis is a chronic inflammatory disease characterized by eosinophilic infiltration and esophagus dysfunction symptoms. Proton pump inhibitor responsive esophageal eosinophilia is similar to eosinophilic esophagitis in terms of clinical, laboratory, genetic expression profile, endoscopic and histopathological features. In this study, we aimed to share demographic features, clinical, laboratory and histopathological findings, and treatment outcomes of patient with eosinophilic esophagitis and proton pump inhibitor responsive esophageal eosinophilia. Materials and Methods: Demographic features, laboratory, endoscopic and histopathological findings, and treatment outcomes of patients followed in our clinic were recorded retrospectively since January 2010. Results: Four thousand six hundred fifty five patients underwent esophagogastroscopy since 2010 in our clinic and 0.4% (n=18) of these patients were diagnosed with eosinophilic esophagitis, and 0.2% (n=8) with proton pump inhibitor-responsive esophageal eosinophilia. The main symptom of patients with eosinophilic esophagitis were food impaction/dysphagia (n=5, 27.8%) and chronic abdominal pain (n=5, 27.8%). Allergen sensitization was found in 14 (77.8%), increased IgE in 12 (66.7%), peripheral eosinophilia in 12 (66.7%), and food allergen sensitization in 10 patients (55.6%) with eosinophilic esophagitis. On histopathological examination, the mean intraepithelial eosinophil count was 48.9 ± 30.9 cells / HPF (400x). When patients with eosinophilic esophagitis (group 1) and proton pump inhibitor-responsive esophageal eosinophilia (group 2) were compared, it was found that chronic abdominal pain was more common in the proton pump inhibitor-responsive esophageal eosinophilia group and food allergen sensitization in the eosinophilic esophagitis group (p<0.05). Total IgE, peripheral eosinophil count and intraepithelial eosinophil count were higher in the eosinophilic esophagitis group, but the differences were not statistically significant. Diet (n=11), medical (n=17) and dilatation (n=1) therapies were used in the eosinophilic esophagitis group. Fibrosis was detected on the histopathological examination in two patients who underwent TED and then SED was started. No side effect was seen any group in long term. Conclusion: Eosinophilic esophagitis and proton pump inhibitor-responsive esophageal eosinophilia have similar laboratory and histopathological features but eosinophilic esophagitis should be suspected more frequently in the presence of food allergy. Long-term followup is essential in patients with eosinophilic esophagitis.","PeriodicalId":42004,"journal":{"name":"Astim Allerji Immunoloji","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2019-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48920524","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}
F. Akpinar, G. Kutluk, Gulcan Ozomay, O. Yorbik, F. Çeti̇nkaya
Objective: Allergic diseases and autism spectrum disorders (ASD) affect millions of children worldwide and the frequencies of these diseases are increasing. Although some genetic and environmental factors have been implicated, the exact reasons of this increase have not been determined yet. In this study, we aimed to investigate the frequencies of allergic diseases among children with ASD. Materials and Methods: A questionnaire containing 23 questions related to asthma, allergic rhinitis, atopic dermatitis and food allergy adapted from the International Study of Asthma and Allergies in Childhood (ISAAC) was used and the questionnaires were filled out by the parents of children with ASD and controls. Results: The study and control groups comprised 59 and 50 children respectively. Allergic rhinitis was diagnosed in 12%, atopic dermatitis in 10.1%, food allergy in 8.4% and asthma in 6.8% of the children with ASD; and 16%, 6%, 8% and 10.0% respectively in the control group. Conclusion: These results suggest that frequency of allergic diseases among children with ASD are not different than controls.
{"title":"Frequencies of Allergic Diseases Among Children with Autism Spectrum Disorders","authors":"F. Akpinar, G. Kutluk, Gulcan Ozomay, O. Yorbik, F. Çeti̇nkaya","doi":"10.21911/AAI.170","DOIUrl":"https://doi.org/10.21911/AAI.170","url":null,"abstract":"Objective: Allergic diseases and autism spectrum disorders (ASD) affect millions of children worldwide and the frequencies of these diseases are increasing. Although some genetic and environmental factors have been implicated, the exact reasons of this increase have not been determined yet. In this study, we aimed to investigate the frequencies of allergic diseases among children with ASD. Materials and Methods: A questionnaire containing 23 questions related to asthma, allergic rhinitis, atopic dermatitis and food allergy adapted from the International Study of Asthma and Allergies in Childhood (ISAAC) was used and the questionnaires were filled out by the parents of children with ASD and controls. Results: The study and control groups comprised 59 and 50 children respectively. Allergic rhinitis was diagnosed in 12%, atopic dermatitis in 10.1%, food allergy in 8.4% and asthma in 6.8% of the children with ASD; and 16%, 6%, 8% and 10.0% respectively in the control group. Conclusion: These results suggest that frequency of allergic diseases among children with ASD are not different than controls.","PeriodicalId":42004,"journal":{"name":"Astim Allerji Immunoloji","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2019-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42176145","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}
In this study, atmospheric pollen data of previous studies belonging to 54 different stations in Turkey, conducted by using the gravimetric and/or volumetric method, were evaluated in terms of flora, biogeography and aeropalynology. In line with these data, Turkey is divided into 5 aeropalyno-geographical regions, which are represented with their characteristics (North, West, South, Central, and East), and the skin prick tests were evaluated on the basis of pollen allergy data regionally and concurrently. In general, the dominant pollen seen in Turkey’s atmosphere has been found to be represented by 29 different types. The pollen sum of these 29 taxa was found to represent more than 85% of the total pollen concentration detected in the atmosphere when evaluated according to different regions. Of these pollen types, 20 belong to woody and nine belong to herbaceous plants. It has generally been reported that there are higher pollen concentrations of woody plants in the atmosphere in Turkey. Overall, Cupressaceae/Taxaceae, Pinus, and Gramineae pollen were found as the common types to all of Turkey’s five aeropalynogeographic regions, in which they were recorded within the first three dominant pollen types. It has also been observed that Quercus, Platanus and Populus pollen from woody plants, and Amaranthaceae and Urticaceae pollen from the herbaceous plants were commonly recorded in high amounts for all regions. However, when the revised data are examined in detail, it has been determined that tree pollen like Fagus, Carpinus, Alnus, Corylus and Betula in the atmosphere were characteristic for the North Turkey region; the highest amounts of Olea europaea pollen for the West Turkey region; higher quantities of the Cupressaceae/Taxaceae pollen for the South Turkey region; and very high amounts of Gramineae, Morus, Fraxinus and Artemisia pollen for the East Turkey region have been recorded as characteristic in the atmosphere. Compared with Europe; Morus, Salix, Populus, Mercurialis and Plantago pollen in the atmosphere of Turkey differ in their presence and quantity. On the other hand, invasive plants such as Ambrosia and Ailanthus or exotic plants such as Casuarina and Eucalyptus, which have allergenic pollen, must be remembered among the dominant taxa in the air in different regions on a seasonal basis. It has been shown that the ideal allergen panels have to be updated according to the area and especially by including the dominant taxa. However, these updates should be made by taking into account crossreactions, and at least one of the reacting taxa should be included in the panel.
{"title":"Allergenic Pollen in Turkey","authors":"A. Bicakci, A. Tosunoglu","doi":"10.21911/aai.434","DOIUrl":"https://doi.org/10.21911/aai.434","url":null,"abstract":"In this study, atmospheric pollen data of previous studies belonging to 54 different stations in Turkey, conducted by using the gravimetric and/or volumetric method, were evaluated in terms of flora, biogeography and aeropalynology. In line with these data, Turkey is divided into 5 aeropalyno-geographical regions, which are represented with their characteristics (North, West, South, Central, and East), and the skin prick tests were evaluated on the basis of pollen allergy data regionally and concurrently. In general, the dominant pollen seen in Turkey’s atmosphere has been found to be represented by 29 different types. The pollen sum of these 29 taxa was found to represent more than 85% of the total pollen concentration detected in the atmosphere when evaluated according to different regions. Of these pollen types, 20 belong to woody and nine belong to herbaceous plants. It has generally been reported that there are higher pollen concentrations of woody plants in the atmosphere in Turkey. Overall, Cupressaceae/Taxaceae, Pinus, and Gramineae pollen were found as the common types to all of Turkey’s five aeropalynogeographic regions, in which they were recorded within the first three dominant pollen types. It has also been observed that Quercus, Platanus and Populus pollen from woody plants, and Amaranthaceae and Urticaceae pollen from the herbaceous plants were commonly recorded in high amounts for all regions. However, when the revised data are examined in detail, it has been determined that tree pollen like Fagus, Carpinus, Alnus, Corylus and Betula in the atmosphere were characteristic for the North Turkey region; the highest amounts of Olea europaea pollen for the West Turkey region; higher quantities of the Cupressaceae/Taxaceae pollen for the South Turkey region; and very high amounts of Gramineae, Morus, Fraxinus and Artemisia pollen for the East Turkey region have been recorded as characteristic in the atmosphere. Compared with Europe; Morus, Salix, Populus, Mercurialis and Plantago pollen in the atmosphere of Turkey differ in their presence and quantity. On the other hand, invasive plants such as Ambrosia and Ailanthus or exotic plants such as Casuarina and Eucalyptus, which have allergenic pollen, must be remembered among the dominant taxa in the air in different regions on a seasonal basis. It has been shown that the ideal allergen panels have to be updated according to the area and especially by including the dominant taxa. However, these updates should be made by taking into account crossreactions, and at least one of the reacting taxa should be included in the panel.","PeriodicalId":42004,"journal":{"name":"Astim Allerji Immunoloji","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2019-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42094446","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}
Allergic diseases are attributed to modern times and urban lifestyle. This manuscript discusses the narrations mentioned about suspected allergic disorders within Egyptian, Chinese, and Greco-Roman texts that represent the prominent civilizations of antiquity and also the quoted symptoms observed in some historically important figures, which might be considered as rudimentary case reports. The symptoms mentioned in ancient texts are only suggestive of allergic diseases. The present evidence is not conclusive enough to assert that allergic diseases were prevalent –at least not as much as today- in that age.
{"title":"Were Allergic Diseases Prevalent in Antiquity?","authors":"Kürşat Epöztürk, Ş. Görkey","doi":"10.21911/AAI.406","DOIUrl":"https://doi.org/10.21911/AAI.406","url":null,"abstract":"Allergic diseases are attributed to modern times and urban lifestyle. This manuscript discusses the narrations mentioned about suspected allergic disorders within Egyptian, Chinese, and Greco-Roman texts that represent the prominent civilizations of antiquity and also the quoted symptoms observed in some historically important figures, which might be considered as rudimentary case reports. The symptoms mentioned in ancient texts are only suggestive of allergic diseases. The present evidence is not conclusive enough to assert that allergic diseases were prevalent –at least not as much as today- in that age.","PeriodicalId":42004,"journal":{"name":"Astim Allerji Immunoloji","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2018-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43831794","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}
Duru Tabanlıoğlu-Onan, Ayşe Öktem, B. Yalçın, F. Artüz
Objective: Chronic spontaneous urticaria is a disorder characterized by spontaneous development of pruritic erythematous plaques, angioedema or both. Omalizumab is a recombinant monoclonal antibody that selectively binds to IgE and inhibits its binding to FceRI receptors on mast cells and basophils. We sought to retrospectively assess the efficacy of Omalizumab, the adverse effects due to treatment, and the disease-free duration after treatment in treatment-resistant chronic spontaneous urticaria cases. Materials and Methods: The treatment responses of 24 chronic spontaneous urticaria cases treated with Omalizumab at our clinic were retrospectively evaluated. Results: The mean age of the patients was 44 years and the mean duration of disease was 7.2 years. The most common concomitant systemic disease was thyroid disease (29%). The duration of treatment ranged from 4 to 36 months, and total treatment doses from 5 to 28 doses. The treatment of 15 patients was still going on and the mean duration of treatment was 24.4 months. Disease control could not be achieved in three patients but the mean dose of disease control was 3.2 in the other patients. The treatment response was partial in 29% (n=7) and complete in 71% (n=17) of the patients. Side effects (erythema or urticarial plaque at the injection area, headache, dizziness, myalgia, arthralgia) were detected in eight patients. No recurrence was detected in five patients with a mean follow-up duration of 12 months after the treatment. The mean duration until recurrence was 7.7 months after the treatment in five patients who had recurrence. Conclusion: Omalizumab is a good treatment option, thanks to its efficacy and safety, in chronic spontaneous urticaria patients who do not respond to H1-antihistamines.
{"title":"Efficacy of Omalizumab in Treatment-Resistant Chronic Spontaneous Urticaria","authors":"Duru Tabanlıoğlu-Onan, Ayşe Öktem, B. Yalçın, F. Artüz","doi":"10.21911/AAI.413","DOIUrl":"https://doi.org/10.21911/AAI.413","url":null,"abstract":"Objective: Chronic spontaneous urticaria is a disorder characterized by spontaneous development of pruritic erythematous plaques, angioedema or both. Omalizumab is a recombinant monoclonal antibody that selectively binds to IgE and inhibits its binding to FceRI receptors on mast cells and basophils. We sought to retrospectively assess the efficacy of Omalizumab, the adverse effects due to treatment, and the disease-free duration after treatment in treatment-resistant chronic spontaneous urticaria cases. Materials and Methods: The treatment responses of 24 chronic spontaneous urticaria cases treated with Omalizumab at our clinic were retrospectively evaluated. Results: The mean age of the patients was 44 years and the mean duration of disease was 7.2 years. The most common concomitant systemic disease was thyroid disease (29%). The duration of treatment ranged from 4 to 36 months, and total treatment doses from 5 to 28 doses. The treatment of 15 patients was still going on and the mean duration of treatment was 24.4 months. Disease control could not be achieved in three patients but the mean dose of disease control was 3.2 in the other patients. The treatment response was partial in 29% (n=7) and complete in 71% (n=17) of the patients. Side effects (erythema or urticarial plaque at the injection area, headache, dizziness, myalgia, arthralgia) were detected in eight patients. No recurrence was detected in five patients with a mean follow-up duration of 12 months after the treatment. The mean duration until recurrence was 7.7 months after the treatment in five patients who had recurrence. Conclusion: Omalizumab is a good treatment option, thanks to its efficacy and safety, in chronic spontaneous urticaria patients who do not respond to H1-antihistamines.","PeriodicalId":42004,"journal":{"name":"Astim Allerji Immunoloji","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2018-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47810355","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}
Objective: Intravenous immunoglobulin preparations have been used in the treatment of primary immunodeficiency for many years. Recently, immunoglobulin administration via the subcutaneous route has become popular. Subcutaneously administered immunoglobulin provides more stable serum immunoglobulin levels and has a lower incidence of systemic adverse effects than the intravenous route. This method increases the quality of the patient’s life by self administration or parental administration at home. Immunoglobulin preparations designed for subcutaneous administration have been available in Europe and the US since 2006. Although subcutaneous immunoglobulin preparations are not available in Turkey, the subcutaneous administration route has recently been included in the instructions of the three intravenous products with 10% concentration. Our aim was to use one of these intravenous immunoglobulin preparations via the subcutaneous route and describe its advantages and disadvantages. Materials and Methods: Six primary immunodeficiency patients were selected from our clinic. The procedure was described and informed consent obtained. They had been treated with intravenous immunoglobulin for the last few years. Their monthly immunoglobulin dosage was calculated and roughly divided into weekly doses. The first few administrations took place under medical supervision at the hospital until the patients and/or their family learned the procedure. Results: They were encouraging with fewer side effects, better life quality and lower infection rates in our small sample of patients. Conclusion: In this article, we describe our experience with 6 primary immunodeficiency patients of our clinic in whom we successfully used intravenous immunoglobulin preparation via the subcutaneous route.
{"title":"Subcutaneous Immunoglobulin Replacement Therapy Experience with Intravenous Preparation","authors":"Ö. Özdemir","doi":"10.21911/AAI.404","DOIUrl":"https://doi.org/10.21911/AAI.404","url":null,"abstract":"Objective: Intravenous immunoglobulin preparations have been used in the treatment of primary immunodeficiency for many years. Recently, immunoglobulin administration via the subcutaneous route has become popular. Subcutaneously administered immunoglobulin provides more stable serum immunoglobulin levels and has a lower incidence of systemic adverse effects than the intravenous route. This method increases the quality of the patient’s life by self administration or parental administration at home. Immunoglobulin preparations designed for subcutaneous administration have been available in Europe and the US since 2006. Although subcutaneous immunoglobulin preparations are not available in Turkey, the subcutaneous administration route has recently been included in the instructions of the three intravenous products with 10% concentration. Our aim was to use one of these intravenous immunoglobulin preparations via the subcutaneous route and describe its advantages and disadvantages. Materials and Methods: Six primary immunodeficiency patients were selected from our clinic. The procedure was described and informed consent obtained. They had been treated with intravenous immunoglobulin for the last few years. Their monthly immunoglobulin dosage was calculated and roughly divided into weekly doses. The first few administrations took place under medical supervision at the hospital until the patients and/or their family learned the procedure. Results: They were encouraging with fewer side effects, better life quality and lower infection rates in our small sample of patients. Conclusion: In this article, we describe our experience with 6 primary immunodeficiency patients of our clinic in whom we successfully used intravenous immunoglobulin preparation via the subcutaneous route.","PeriodicalId":42004,"journal":{"name":"Astim Allerji Immunoloji","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2018-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41336045","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}
Kadriye Terzioğlu, Raziye Tülümen Öztürk, Eda Durmuş, Dane Ediger
{"title":"Nonsteroid Antienflamatuvar İlaçlarla Alevlenen Havayolu Hastalığı Olan Hastada Oral Metilprednisolona Bağlı Gelişen Hipersensitivite Reaksiyonu","authors":"Kadriye Terzioğlu, Raziye Tülümen Öztürk, Eda Durmuş, Dane Ediger","doi":"10.21911/aai.346","DOIUrl":"https://doi.org/10.21911/aai.346","url":null,"abstract":"","PeriodicalId":42004,"journal":{"name":"Astim Allerji Immunoloji","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68359745","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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