European Neurology最新文献

{"title":"Relevance of Continuous EEG versus Routine EEG for Outcome Prediction after Traumatic Brain Injury.","authors":"Valentin Loser, Andrea O Rossetti, Marija Rasic, Jan Novy, Kaspar A Schindler, Stephan Rüegg, Vincent Alvarez, Isabelle Beuchat","doi":"10.1159/000541335","DOIUrl":"10.1159/000541335","url":null,"abstract":"<p><strong>Introduction: </strong>In a cohort of adult patients with disturbance of consciousness after TBI, we aimed to explore the relationship of continuous video-EEG (cEEG) versus routine EEG (rEEG) with mortality and functional outcome.</p><p><strong>Methods: </strong>This is a post hoc analysis of a randomized controlled trial (CERTA), in which adults with disorder of consciousness and needing EEG (excluding those with proven seizures/SE just before) were randomized 1:1 to cEEG or two rEEG. In TBI patients, correlation between EEG duration, mortality, and modified Rankin score (mRs, good 0-2) at 6 months was assessed.</p><p><strong>Results: </strong>Among 364 patients, 44 presenting with consciousness impairment after TBI were included; 29 randomized to cEEG and 15 to rEEG. Mortality (p = 0.88) and functional outcome (p = 0.58) at 6 months were similar between groups. There was a nonsignificant tendency toward more seizure/status epilepticus detection with cEEG (p = 0.08). In multivariable regression, cEEG was not related to functional outcome (OR: 0.75 [0.13-4.24], p = 0.745) or mortality (OR: 7.11 [0.51-99.32], p = 0.145).</p><p><strong>Conclusion: </strong>Despite allowing increased seizure detections in TBI patients, cEEG does not seem to be associated with better functional outcome or mortality over rEEG. Pending larger trials, repeated rEEG might be acceptable in post-TBI disorder of consciousness, especially in resource-limited environments.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"306-311"},"PeriodicalIF":2.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Cerebellar Repetitive Transcranial Magnetic Stimulation in the Treatment of Post-Stroke Dysphagia: A Meta-Analysis and Systematic Review of Randomized Controlled Trials.","authors":"Ying Liu, Shao Yin, Xinwei Yang, Shanshan Luo, Fengya Zhu, Zijian Zeng, Qian Hu, Li Xu, Qian Yu","doi":"10.1159/000538130","DOIUrl":"10.1159/000538130","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to comprehensively evaluate the therapeutic efficacy of cerebellar repetitive transcranial magnetic stimulation (rTMS) in the rehabilitation of post-stroke dysphagia (PSD).</p><p><strong>Methods: </strong>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched PubMed, Cochrane Library, Embase, and Web of Science to identify relevant randomized controlled trials (RCTs) investigating the application of cerebellar rTMS in the treatment of PSD. Inclusion and exclusion criteria were rigorously applied during the screening process, and pertinent characteristics of the included RCTs were meticulously extracted. The I2 statistic was employed to assess heterogeneity, and meta-analysis was conducted using Stata 17 software. The Cochrane Risk of Bias 2 tool and PEDro scale were utilized to evaluate bias risk and literature quality.</p><p><strong>Results: </strong>Our analysis encompassed a total of 5 RCTs involving 673 patients with dysphagia who met the inclusion criteria. The findings indicated a significant positive impact of cerebellar rTMS when combined with traditional swallowing exercises on PSD, demonstrating superior efficacy compared to conventional swallowing exercises in isolation. Furthermore, the study revealed no statistically significant differences based on stimulation site (unilateral vs. bilateral cerebellum), stimulation mode (rTMS vs. intermittent theta-burst stimulation), and stimulation frequency (5 Hz vs. 10 Hz).</p><p><strong>Conclusion: </strong>The amalgamation of cerebellar rTMS with conventional swallowing exercises demonstrates notable efficacy, surpassing the outcomes achievable with traditional exercises alone. The sustained effectiveness observed underscores the potential of cerebellar rTMS as an innovative avenue in the field of neurorehabilitation for PSD. This study contributes valuable insights into the prospect of utilizing cerebellar rTMS as an adjunctive therapeutic strategy in the management of PSD, emphasizing its relevance for further exploration and clinical application.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"67-78"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140021281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ego- and Geo-Centered References: A Functional Neuroimagery Study.","authors":"Arnaud Saj, Jacques Honoré, Liliane Borel","doi":"10.1159/000535725","DOIUrl":"10.1159/000535725","url":null,"abstract":"<p><strong>Introduction: </strong>The integration of vestibular, visual, and somatosensory cues allows the perception of space through the orientation of our body and surrounding objects with respect to gravity. The main goal of this study was to identify the cortical networks recruited during the representation of body midline and the representation of verticality.</p><p><strong>Methods: </strong>Thirty right-handed healthy participants were evaluated using fMRI. Brain networks activated during a subjective straight-ahead (SSA) task were compared to those recruited during a subjective vertical (SV) task.</p><p><strong>Results: </strong>Different patterns of cortical activation were observed, with differential increases in the angular gyrus and left cerebellum posterior lobe during the SSA task, in right rolandic operculum and cerebellum anterior lobe during the SV task.</p><p><strong>Discussion: </strong>The activation of these areas involved in visuo-spatial functions suggests that bodily processes of great complexity are engaged in body representation and vertical perception. Interestingly, the common brain networks involved in SSA and SV tasks were comprised of areas of vestibular projection that receive multisensory information (parieto-occipital areas) and the cerebellum, and reveal a predominance of the right cerebral and cerebellar hemispheres. The outcomes of this first fMRI study designed to unmask common and specific neural mechanisms at work in gravity- or body-referenced tasks pave a new way for the exploration of spatial cognitive impairment in patients with vestibular or cortical disorders.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"36-42"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139477534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Everyday Memory Disturbance in Primary Progressive Aphasia.","authors":"David Foxe, Gyan Ainkaran, James Carrick, Sau Chi Cheung, Rebekah M Ahmed, Manisha Narasimhan, James R Burrell, Yun Tae Hwang, Muireann Irish, Olivier Piguet","doi":"10.1159/000540340","DOIUrl":"10.1159/000540340","url":null,"abstract":"<p><strong>Introduction: </strong>Mounting evidence indicates distinct memory profiles among the primary progressive aphasia (PPA) variants. Neuropsychological tests reveal disproportionate memory impairments in the logopenic variant PPA (lv-PPA) relative to the non-fluent variant PPA (nfv-PPA) and semantic variant PPA (sv-PPA). The real-world experience of day-to-day memory disturbances in PPA, however, remains poorly understood.</p><p><strong>Methods: </strong>Everyday expressions of memory in 26 lv-PPA, 24 nfv-PPA, and 40 sv-PPA patients, and 70 healthy controls were examined using the Cambridge Behavioural Inventory-Revised (CBI-R) carer questionnaire. Kruskal-Wallis tests compared CBI-R Memory items (1-8) across groups. Receiver operating characteristic curves evaluated the most discriminative items to distinguish lv-PPA from nfv-PPA.</p><p><strong>Results: </strong>Compared to controls, lv-PPA and sv-PPA patients were reported to experience more day-to-day memory issues (item 1), increased repetition of questions (2), forgetting the names of familiar people and objects (4, 5), and poor concentration (6). lv-PPA patients were also reported to exhibit more occurrences of losing or misplacing items (3) and forgetting the day (7). All PPA groups experienced more confusion in unfamiliar environments (8) than controls. Direct comparisons among PPA groups revealed distinct profiles, with lv-PPA and sv-PPA patients exhibiting more frequent forgetting of names and objects (3, 4) than nfv-PPA, and sv-PPA demonstrating greater day-to-day memory impairment (1), repeated questions (2), and poor concentration (6) compared to nfv-PPA. Forgetting the names of familiar objects (5) was the most sensitive and specific item to distinguish lv-PPA from nfv-PPA.</p><p><strong>Conclusions: </strong>Our findings demonstrate distinct day-to-day memory profiles in PPA. Future research should explore the influence of language impairments on these profiles.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"177-187"},"PeriodicalIF":2.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the COVID-19 Pandemic on Acute Stroke Rehabilitation in Japanese Primary Stroke Centers: A Nationwide Cross-Sectional Study Using a Web-Based Questionnaire Survey.","authors":"Naoki Oyama, Koichi Oki, Makoto Nakajima, Koichi Matsumoto, Tomohiro Omori, Makoto Hayase, Tsuyoshi Ohta, Masatoshi Koga, Tetsuo Koyama, Shigeru Fujimoto, Yasuyuki Iguchi, Wataru Kakuda, Kuniaki Ogasawara","doi":"10.1159/000540231","DOIUrl":"10.1159/000540231","url":null,"abstract":"<p><strong>Introduction: </strong>Acute stroke rehabilitation is crucial for achieving good functional recovery, even during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to clarify the impact of the COVID-19 pandemic on acute stroke rehabilitation and identify which components in the acute stroke rehabilitation provision system were susceptible to the pandemic.</p><p><strong>Methods: </strong>A web-based questionnaire survey was conducted in all primary stroke centers (PSCs) in Japan between February 7 and April 21, 2022. The survey included questions about the current status of acute stroke rehabilitation and the influence of the pandemic. We classified the influences and investigated the relationship between the influence of the pandemic and the provision of rehabilitation. Additionally, we investigated a group of prefectures divided according to the grade of the pandemic.</p><p><strong>Results: </strong>The survey response rate was 67% (639 of 959 PSCs). Among them, 387 PSCs (61%) reported that the COVID-19 pandemic affected acute stroke rehabilitation. In PSCs affected by the pandemic, more rehabilitation-related staff were working, and the proportion of weekend/holiday rehabilitation implementation was higher compared to those unaffected. In PSCs from highly infected prefectures, no significant relationship was observed between the influence of the pandemic and the rehabilitation provision system.</p><p><strong>Conclusions: </strong>PSCs that provide denser acute stroke rehabilitation may be affected to a greater extent by the pandemic. We conclude that stroke hospitals should formulate infection control procedures for acute stroke rehabilitation in advance, depending on the conditions of the region and facility.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"169-176"},"PeriodicalIF":2.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Body Mass Index or Serum Albumin and Different Dementia Populations.","authors":"Xia Yang, Ling-Yun Ma, Moyu Li, Yong Ji","doi":"10.1159/000540317","DOIUrl":"10.1159/000540317","url":null,"abstract":"<p><strong>Introduction: </strong>There is limited understanding of body mass index (BMI) and serum albumin levels in patients with dementia. This study aimed to investigate the association between BMI, serum albumin levels, and dementia in patients with Alzheimer's disease (AD), dementia with Lewy bodies (DLB), and Parkinson's disease with dementia (PDD).</p><p><strong>Methods: </strong>A total of 336 patients with dementia (173 with AD, 112 with DLB, 51 with PDD) and 220 healthy controls were recruited. Pearson and Spearman correlation analyses were performed to examine the relationships between BMI or serum albumin and MMSE scores, as well as neuropathological markers. Logistic regression models were used to analyze the data, adjusting for confounding variables.</p><p><strong>Results: </strong>Using the highest BMI quartile (≥26.04 kg/m2) and serum albumin quartile (≥41.21 g/L) as reference groups, the lowest BMI quartile (&lt;21.91 kg/m2) was significantly associated with AD (p &lt; 0.001) and DLB (p = 0.003). The lowest serum albumin quartile (≤37.60 g/L) was independently associated with DLB (p &lt; 0.001) and AD (p = 0.006). In AD patients, BMI was associated with Aβ1-42 and p-Tau181 in cerebrospinal fluid after controlling for confounders, while serum albumin was correlated with T-Tau and T-tau/Aβ1-42 (p &lt; 0.05).</p><p><strong>Conclusion: </strong>Decreased serum albumin and BMI levels are associated with DLB and AD in dementia patients. Although no correlation was found between BMI or serum albumin and MMSE scores, there was a significant association with AD cerebrospinal fluid pathologic markers.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"159-168"},"PeriodicalIF":2.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141855298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Intraoperative Neurophysiological Monitoring in Predicting Postoperative Delirium in Patients Undergoing Carotid Endarterectomy Surgeries.","authors":"Abdullah M Al-Qudah, Sreeja Sivaguru, Katherine M Anetakis, Donald Crammond, Jeffrey R Balzer, Kathirvel Subramaniam, Senthilkumar Sadhasivam, Varun Shandal, Parthasarathy D Thirumala","doi":"10.1159/000540311","DOIUrl":"10.1159/000540311","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate the diagnostic utility of electroencephalography (EEG) and somatosensory evoked potentials (SSEP) as modalities of intraoperative neurophysiological monitoring (IONM) in predicting postoperative delirium (POD) in patients who underwent carotid endarterectomy (CEA) surgery.</p><p><strong>Methods: </strong>A total cohort of 425 patients was included in this study. Medical record data were reviewed retrospectively and their documented significant IONM data were analyzed and integrated into the study for each patient. The study cohort was assessed for POD with the Intensive Care Delirium Screening Checklist (ICDSC), and a score of >4 was positive for delirium.</p><p><strong>Results: </strong>Of the 425 patients who underwent CEA for carotid stenosis, 65 (15.29%) had documented significant IONM changes. Of those 65 patients with significant changes, 16 (24.61%) had POD. On the other hand, of the 360 patients without changes, 31 (8.61%) had POD. Utilizing logistic regression while adjusting for possible confounders, IONM changes were still significantly associated with POD (p value: <0.001; 95% confidence interval (CI): 1.91-7.98; adjusted odds ratio (ORadj): 3.94). Specifically, SSEP changes alone were significantly associated with POD (p value: <0.001; 95% CI: 2.36-11.08; ORadj: 5.15).</p><p><strong>Conclusion: </strong>Significant IONM changes increase the risk of developing POD in patients undergoing CEA. Despite the low overall risk of POD after CEA in our study, it is imperative to conclude that patients with POD are twice as likely to exhibit IONM changes.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"242-249"},"PeriodicalIF":2.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Neurologist: Charles Foix as a Poet and a Playwright.","authors":"Camila Lorenzini Tessaro, João Gabriel Cavazzani Doubek, Matheus Kahakura Franco Pedro","doi":"10.1159/000539145","DOIUrl":"10.1159/000539145","url":null,"abstract":"<p><strong>Background: </strong>Charles Foix (1882-1927) may be mostly remembered today due to his contributions to vascular neurology and the syndromes that bear his name, such as the Foix-Alajouanine syndrome. However, he also developed a literary career and composed poetry and a vast collection of plays, often dealing with biblical themes or figures from Greek mythology.</p><p><strong>Summary: </strong>His poetry was often inspired by his own experiences during the First World War, in which he was assigned to serve as a medical officer in Greece, becoming enamored with his surroundings and the classical lore.</p><p><strong>Key messages: </strong>The authors explore Foix's poetry and drama and their relationship to his overall work as a neurologist, including his wartime experiences.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"140-146"},"PeriodicalIF":2.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathophysiology of Contrast-Induced Neurotoxicity: A Narrative Review of Possible Mechanisms.","authors":"Frederick P Mariajoseph, Leon Lai, Justin Moore, Ronil Chandra, Tony Goldschlager, Adrian J Praeger, Lee-Anne Slater","doi":"10.1159/000535928","DOIUrl":"10.1159/000535928","url":null,"abstract":"<p><strong>Background: </strong>Contrast-induced neurotoxicity (CIN) is an increasingly observed event following the administration of iodinated contrast. It presents as a spectrum of neurological symptoms that closely mimic ischaemic stroke, however, CIN remains a poorly understood clinical phenomenon. An appreciation of the underlying pathophysiological mechanisms is essential to improve clinical understanding and enhance decision-making.</p><p><strong>Methods: </strong>A broad literature search of Medline (1946 to December 2022) and Embase (1947 to December 2022) was conducted. Articles discussing the pathophysiology of CIN were reviewed.</p><p><strong>Summary: </strong>The pathogenesis of CIN appears to be multifactorial. A key step is likely blood-brain barrier (BBB) breakdown due to factors including ischaemic stroke, uncontrolled hypertension, and possibly contrast agents themselves, among others. This is followed by passage of contrast agents across the BBB, leading to chemotoxic sequelae on neural tissue.</p><p><strong>Key messages: </strong>This review provides a clinically oriented review on the pathophysiology of CIN to enhance knowledge and improve decision-making among clinicians.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"26-35"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11003557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138828958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causal Relationship between Parkinson's Disease with Heart and Vascular Disease: A Two-Sample Mendelian Randomization Study.","authors":"Lize Chen, Qiushi Zhang, Shiduo Li, Haoran Chen, Jing Guo, Zongmao Zhao, Jing Tong","doi":"10.1159/000536484","DOIUrl":"10.1159/000536484","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to investigate the causal relationship between Parkinson's disease (PD) and myocardial infarction (MI), atrial fibrillation and flutter (AF), and venous thromboembolism (VTE) by Mendelian randomization (MR) analysis.</p><p><strong>Methods: </strong>By using data from publicly available genome-wide association studies from databases, single nucleotide polymorphisms were screened as instrumental variables, and the MR analysis was finished by inverse-variance weighted (IVW), MR-egger, weighted median methods.</p><p><strong>Results: </strong>The primary IVW method showed a negative association between genetically predicted PD and risk of MI (OR = 0.9989; 95% CI: 0.9980-0.9998; p = 0.02). However, PD was not significantly associated with AF or VTE.</p><p><strong>Conclusion: </strong>This study suggests a negative association between PD with MI, which implies that PD has a protective effect on MI.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"11-16"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10997265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139697194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}