Indian Journal of Otolaryngology and Head and Neck Surgery最新文献

{"title":"Comparative Arterial Blood Gas Analysis in Post Septoplasty Patients with Conventional Nasal Packs Versus Nasal Packs with Airway.","authors":"Ramya Rajpurohit, Neha Salaria, Uma Garg","doi":"10.1007/s12070-023-03847-6","DOIUrl":"10.1007/s12070-023-03847-6","url":null,"abstract":"<p><p>To evaluate levels of arterial blood gases in patients undergoing septoplasty, with conventional nasal packing versus those with nasal packing with airway. The current prospective comparative study was conducted on 68 patients undergoing septoplasty, who were divided randomly into two groups-conventional nasal packs (ANP) and nasal packs with airway (ANP-A). Arterial blood gas analysis alongwith objective symptoms of patients were recorded and evaluated. The difference between pre and post operative values of SpO₂ (ANP = 6.73 ± 1.17, ANP-A = 2.84 ± 0.91) and pO₂ (ANP = 15.09 ± 4.34, ANP-A = 3.46 ± 1.49) between the two groups was statistically significant (<i>p</i> = 0.001). Differences in post operative pH, pCO₂ and HCO₃ between the two groups was not statistically significant. Significant difference between the two groups was observed in patients' objective symptoms as well. Nasal packs with airway have lesser perturbing effects on septoplasty patients as compared to conventional nasal packs.</p>","PeriodicalId":13287,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"1 1","pages":"2802-2808"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10645705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42511165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polysomnographic Findings Versus Degree of Obstruction During Drug-Induced Sleep Endoscopy and Muller's Maneuver.","authors":"Amin Amali, Reza Erfanian, Behrooz Amirzargar, Mohammad Sadeghi, Babak Saedi, Hamed Emami, Reihaneh Heidari, Fatemeh Mirashrafi, Saeed Golparvaran","doi":"10.1007/s12070-023-03871-6","DOIUrl":"10.1007/s12070-023-03871-6","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate associations between polysomnographic findings and the severity of upper airway obstructions during Muller's Maneuver (MM) and Drug-Induced Sleep Endoscopy (DISE) in patients with obstructive sleep apnea syndrome (OSAS).</p><p><strong>Methods: </strong>This was a prospective cohort study. Adult patients newly diagnosed with OSAS in a tertiary sleep center were included consecutively and evaluated by polysomnography and MM. They then underwent DISE in an operating room. The associations between polysomnographic findings and the severity of upper airway obstructions during MM and DISE were assessed. Also, the degree and pattern of obstructions were compared using a modified VOTE questionnaire.</p><p><strong>Results: </strong>145 patients (mean age 41.5 ± 10.1 years) were enrolled. There were no associations between Respiratory Disturbance Index (RDI), mean and lowest O₂ saturation, and body mass index on the one hand, and obstruction degree in MM and DISE (p > 0.05). However, a significant positive correlation was observed between RDI and total VOTE scores in DISE and MM (r = 0.179, p = 0.031 and r = 0.221, p = 0.008 respectively). There were no differences between MM and DISE in diagnosing the degree of obstruction in the velum area (p = 0.687) and the epiglottis (p = 0.50). However, a significant difference was observed between the two techniques in the oropharynx lateral wall (p < 0.001) and tongue base (p = 0.017).</p><p><strong>Conclusion: </strong>Although there was no association between polysomnographic findings and the severity of obstruction in MM and DISE for the separate levels of the upper airway, obstruction severity may be assessed more accurately by total VOTE score, which is representative of RDI severity.</p>","PeriodicalId":13287,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"1 1","pages":"2769-2776"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10645862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44970480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Imaging in Evaluating Patients for Cochlear Implantation.","authors":"Priyanshi Agarwal, Yamini Gupta, R K Mundra","doi":"10.1007/s12070-023-03845-8","DOIUrl":"10.1007/s12070-023-03845-8","url":null,"abstract":"<p><p>Role of Imaging in evaluating patients for Cochlear Implantation. To assess the role of imaging using High resolution computed tomography (HRCT) and Magnetic resonance imaging (MRI) temporal bone for evaluating candidates for cochlear implantation (CI). It was a prospective study conducted in the department of Otorhinolaryngology at a tertiary care centre, 30 children up to 5 years of age with severe to profound sensorineural hearing loss(SNHL) were included in the study, radiological evaluation was done in all children. 20(66.67%) children were in 2-4 years age group with female preponderance. Radiological abnormalities were reported in 13(43.33%) children. Abnormalities of inner ear were seen in 8(26.67%) cases, which included bilateral cochlear nerve aplasia, unilateral cochlear aplasia with bilateral cochlear nerve aplasia, bilateral severe cochlear hypoplasia, mondini's dysplasia. Cochlear nerve deficiency was found in 3(10%) children and narrow Internal auditory canal in 4(13.33%) children. <i>2(6.67%) patients out of 30 were not the candidates for CI,</i> they had bilateral absent cochlear nerve which is an absolute contraindication for CI. <i>28(93.33%) patients were evaluated as candidates for CI.</i> Imaging is a fundamental part of the preoperative workup for cochlear implantation, HRCT and MRI temporal bone are complementary to each other in evaluating children for cochlear implantation as HRCT is excellent for demonstrating bony details but, lack in providing details of inner ear neural structures and MRI is better than CT in demonstrating vestibulocochlear nerves.</p>","PeriodicalId":13287,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"1 1","pages":"2760-2768"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10646041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45961290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vocal Outcomes Following Pitch Alteration Surgeries.","authors":"Nupur Kapoor Nerurkar, Zainab Nagree, Enu Malik, Jahnavi","doi":"10.1007/s12070-023-03837-8","DOIUrl":"10.1007/s12070-023-03837-8","url":null,"abstract":"<p><p>Our study aims to ascertain the results of speech therapy and surgery in patients who desire pitch alteration. Typically, patients desirous of an increase in their vocal pitch are male-to-female transpersons, and patients desirous of a drop in their pitch are puberphonia patients. This is a 3-year retrospective study of patients who have been operated for pitch alteration. This is a study of seven patients each of Wendlers glottoplasty (WG) and relaxation laryngeal framework surgery (RLFS). The records were reviewed for the preoperative and the 1-year post-operative fundamental frequency (FO), patient subjective satisfaction score (PSSS), and healing time. A total of 7/35 patients of puberphonia underwent RLFS in which the average preoperative F0 was 216 Hz and 1-year post-operative F0 was 114 Hz (<i>p</i> 0.004). The average pre- and post-operative PSSS was 4 and 9 (<i>p</i> 0.0004). Patients of WG had an average preoperative F0 of 153 Hz and 1-year post-operative F0 of 223 Hz (<i>p</i> 0.0005). The average pre and 1-year postoperative PSSS was 4 and 8 (<i>p</i> 0.002). The average healing time was 3 weeks 4 days in the RLFS patients and 8 weeks 5 days for WG patients. The results of RFLS yielded a high PSSS with a pitch drop of more than 100 Hz. The results of WG yielded an increase in the pitch of 70 Hz with a good PSSS. The average healing time taken following WG was double the time taken for RFLS.</p>","PeriodicalId":13287,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"1 1","pages":"2741-2746"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10645986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43740088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sudden Spontaneous Neck Swelling Due to Thyroid Malignancy: A Case Report.","authors":"Kashiroygoud Biradar, Tapasya Bishnoi, Pankaj Kumar Sahu, Marlapudi Sudheer Kumar, Sangineedi Deepthi","doi":"10.1007/s12070-023-03825-y","DOIUrl":"10.1007/s12070-023-03825-y","url":null,"abstract":"<p><p>Sudden spontaneous swelling in the neck is an emergency condition required to be addressed immediately. It poses a diagnostic dilemma. It is extremely rare for a thyroid malignancy to present as a sudden onset neck swelling in a euthyroid young male with no obvious trauma to the neck. This is a rare case report of a follicular variant of papillary carcinoma thyroid presenting as sudden neck swelling to the extent of shifting trachea to other side in a young euthyroid male.</p>","PeriodicalId":13287,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"1 1","pages":"3818-3820"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10645945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45087195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tracheostoma Closure Technique Using Three Local Flaps.","authors":"Reo Miura, Kazuhiro Nakamura, Hiroumi Matsuzaki, Takeshi Oshima","doi":"10.1007/s12070-023-03855-6","DOIUrl":"10.1007/s12070-023-03855-6","url":null,"abstract":"<p><p>When a tracheostoma is no longer needed, the opening normally closes spontaneously after cannula removal, but some cases require tracheostoma closure. This procedure has been well described, but must be performed in such a way as to minimize its invasiveness and complications while securing a high closure rate. Our procedure for conducting tracheostoma closure technique involves the creation of two hinge flaps and one cover flap to close the tracheostomy opening. We reviewed the medical records of 23 patients (12 men, 11 women; mean age 60.0 SD19.7 years) who underwent tracheostoma closure technique between 2001 and 2019. Surgery was indicated for patients in whom closure had not occurred after conservative monitoring for ≥ 2 months following cannula removal. The surgical procedure began by raising two hinge flaps on either side of the tracheostomy opening, turning the skin surface to the luminal side to form the anterior tracheal wall. Rather than a single layer of skin, multiple skin layers were sutured together to prevent air leakage from between hinge flaps. A further cover flap was produced to cover the anterior tracheal wall, closing the tracheostomy opening. Postoperatively, the tracheal lumen was observed via fiberscopy. No stenosis of the tracheal lumen occurred in any patients, and the tracheocutaneous fistula was successfully closed in all cases. Tracheostoma closure technique using hinge flaps to reconstruct the anterior tracheal wall and a cover flap as a skin flap to cover the skin defect appears useful for patients with failure of spontaneous tracheocutaneous fistula closure.</p>","PeriodicalId":13287,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"1 1","pages":"2798-2801"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10645947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44487127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of the Effect of Minimal Sensorineural Hearing Loss on the Central Auditory Processing in Children: A Pilot Study.","authors":"Rodaina Nawaf Mehrez, Samer Mohamad Mohsen","doi":"10.1007/s12070-023-03862-7","DOIUrl":"10.1007/s12070-023-03862-7","url":null,"abstract":"<p><p>Hearing loss is a main cause of poor auditory, academic, and social performance especially in children. This study aimed to find out the relationship between minimal hearing loss (sensorineural or conductive) and the central auditory processing disorders in children. A cross-sectional study was conducted to compare the probability of having central auditory processing disorder in 159 children diagnosed with minimal sensorineural hearing loss and hearing loss caused by otitis media with effusion aged (6-7 years old) in 4 primary schools in Damascus Syria, and 155 children with normal hearing of the same age group using the children's auditory performance scale (C.H.A.P.S). A remarkable statistical difference was found between the two groups with higher scores of C.H.A.P.S scale in the minimal hearing loss group (<i>P</i> value = 0.000 < 0.05). The difference involved all the sub-scales of the C.H.A.P.S scale, which indicates that minimal hearing loss in children can be considered as one important predisposing factor for central auditory processing disorders.</p>","PeriodicalId":13287,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"1 1","pages":"2781-2785"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10645920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44590894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Study of Surgical Outcome in Endoscopic-Assisted Versus Conventional Septoplasty Using Nasal Surgical Questionnaire (NSQ): A Randomized Control Trial.","authors":"Ruman Ahmed, Chandrashekharayya S Hiremath, Prabhu Khavasi, Santosh P Malashetti","doi":"10.1007/s12070-023-04029-0","DOIUrl":"10.1007/s12070-023-04029-0","url":null,"abstract":"<p><p>Deviated nasal septum (DNS) causes nasal obstruction, secretions, decreased sense of smell, bleeding, headache and snoring. This study aims to compare endoscopic-assisted septoplasty versus conventional septoplasty in terms of surgical outcome and intra- and post-operative complications. A prospective study was done on 50 patients aged between 18 and 41 years of which, 41 (82%) cases were males and 9 (18%) were females who had DNS based on clinical examination and diagnostic nasal endoscopy. Patients were randomized by simple randomization into two groups. Functional outcome was assessed using nasal surgical questionnaire (NSQ) prior to and after surgery for 3 months post-operatively and complications associated with the surgery were compared between two groups. In this study, most of the patients had anterior dislocations, present in 37 cases (74%). Improvement in pre- to post-operative visual analogue scale (VAS) for nasal obstruction was significantly better in endoscopic-assisted than conventional septoplasty (<i>p</i> < 0.001*). Pre-and post-operative differences in 4-point likert scale for other nasal symptoms like decreased sense of smell, snoring, secretions, headache and crusting were better in endoscopic-assisted septoplasty (<i>p</i> < 0.001*). Complications in endoscopic-assisted septoplasty were less common compared to conventional septoplasty (<i>p</i> = 0.05). In endoscopic-assisted septoplasty patients, pre-to post-operative NSQ (Nasal Surgical Questionnaire) VAS improvement for nasal obstruction, likert scale change from pre-to post-op were better and complications were lesser compared to conventional septoplasty. This suggests endoscopic-assisted septoplasty has better surgical outcomes and fewer complications and posterior deviations, spurs and inferior deviations can be corrected with ease and fewer complications.</p>","PeriodicalId":13287,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"1 1","pages":"3610-3620"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10645881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81912543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of image resolution and quantification parameters on fdg-pet/ct images in patients with metastatic breast cancer using Q. clear and osem reconstruction techniques","authors":"Tshetiz Dahal, Bimal Nepal","doi":"10.18231/j.ijashnb.2023.017","DOIUrl":"https://doi.org/10.18231/j.ijashnb.2023.017","url":null,"abstract":"We compared the 2-[18F]FDG-PET/CT scans performed for response monitoring in patients with metastatic breast cancer in a prospective setting using the ordered subset expectation maximization (OSEM) algorithm and the bayesian penalized likelihood reconstruction algorithm (Q.Clear) and the image quality and quantification parameters. 35 patients with metastatic breast cancer who were treated and followed up with 2-[18F]FDG-PET/CT were included. A total of 150 scans were evaluated on a five-point scale for the image quality parameters of noise, sharpness, contrast, diagnostic confidence, artefact, and blotchy look while being blinded to the Q.Clear and OSEM reconstruction algorithms. In scans with detectable disease, the lesion with the highest volume of interest was chosen, taking into account both reconstruction techniques' interest levels. For the same heated lesion, SULpeak (g/mL) and SUVmax (g/mL) were contrasted. The OSEM reconstruction had significantly less blotchy appearance than the Q.Clear reconstruction, while there was no significant difference between the two methods in terms of noise, diagnostic confidence, or artefact. Q.Clear had significantly better sharpness (p &amp;#60; 0.002) and contrast (p &amp;#60; 0.002) than the OSEM reconstruction. Quantitative examination of 75/150 scans revealed that Q.Clear reconstruction considerably outperformed OSEM reconstruction in terms of SULpeak (6.33 ± 1.8 vs. 5.85 ± 1.5, p &amp;#60; 0.002) and SUVmax (7.27 ± 5.8 vs. 3.90 ± 2.8, p 0.002). In conclusion, OSEM reconstruction was less blotchy, but Q.Clear reconstruction showed superior sharpness, better contrast, higher SUVmax, and higher SULpeak.","PeriodicalId":13287,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135759777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective study of cerebellopontine angle tumours: A single instituitional study","authors":"Shashivadhanan Sundaravadhanan, B S Faraz Ahmed, Neerav Porwal, Manish Sharma, Mannu Tiwari","doi":"10.18231/j.ijashnb.2023.018","DOIUrl":"https://doi.org/10.18231/j.ijashnb.2023.018","url":null,"abstract":": Cerebellopontine angle (CPA) tumors are rare intracranial neoplasms that arise in the region between the cerebellum and the pons. These tumors can be challenging to treat due to their complex anatomy and proximity to critical neurovascular structures. Surgical intervention is often necessary to achieve a favorable outcome. The primary objectives of this retrospective study are to analyze the clinical and radiological characteristics of cerebellopontine angle tumors, identify pathological types, assess surgical resectability, and evaluate postoperative outcomes. : The study enrolled 14 patients who underwent surgical intervention for cerebellopontine angle tumors at Armed forces medical college, Pune. A retrospective analysis was performed, considering demographic data, clinical presentations, imaging characteristics and surgical outcomes. : Vestibular schwannoma was the predominant tumor type with majority of tumors manifesting between third to fifth decades. Clinical manifestation included SNHL, cerebellar dysfunction, headache and sensory trigeminal dysfunction. A substantial proportion (86%) presented with no useful hearing preoperatively. Surgical outcomes indicated varying degrees of success, with total resection achieved in a subset of cases. Notably, anatomical preservation of the facial nerve was accomplished in a significant proportion of patients. Postoperative assessments, using the House Brackmann system, revealed positive facial nerve function outcomes in a substantial percentage. Complications included cerebrospinal fluid leak (14%), meningitis(7%) and lower cranial nerve paresis (7%). : In conclusion, surgical intervention plays a crucial role in the management of cerebellopontine tumors. The choice of surgical approach should be individualized based on tumor characteristics and patient factors, with the goal of achieving maximum tumor resection while minimizing complications. Further research and advancements in surgical techniques are needed to optimize outcomes for patients with cerebellopontine tumors.","PeriodicalId":13287,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135759773","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}