International journal of surgery最新文献

{"title":"Have new surgical robotic systems brought transformational changes compared to the da Vinci system? Perspectives from thoracic surgeons.","authors":"Xiaoteng Jia, Daqiang Sun","doi":"10.1097/JS9.0000000000002216","DOIUrl":"10.1097/JS9.0000000000002216","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2329-2330"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comprehensive study of efficacy evaluation for kinesio taping in the treatment of lateral humeral epicondylitis.","authors":"Yuanchun Zhu, Yuying Yang, Yuhang Zhang, Mingnan Shi, Runlin Shi, Lixia Chen","doi":"10.1097/JS9.0000000000002174","DOIUrl":"10.1097/JS9.0000000000002174","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2296-2303"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative complications and surgical outcomes of robotic versus laparoscopic pancreaticoduodenectomy: a meta-analysis of propensity-score-matched studies.","authors":"Gang Tang, Jie Zhang, Linyu Zhang, Lingying Xia, Rui Chen, Rongxing Zhou","doi":"10.1097/JS9.0000000000002196","DOIUrl":"10.1097/JS9.0000000000002196","url":null,"abstract":"<p><strong>Background: </strong>Robotic pancreaticoduodenectomy (RPD) is used more commonly, but high-level evidence is still scarce. This meta-analysis aimed to compare the short-term outcomes between RPD and laparoscopic pancreaticoduodenectomy (LPD) using data collected from propensity score-matched (PSM) studies.</p><p><strong>Materials and methods: </strong>We searched PubMed, Cochrane Library, Embase, and Web of Science databases for PSM studies comparing RPD and LPD. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals were calculated.</p><p><strong>Results: </strong>Ten PSM studies were included, encompassing 8106 patients (RPD group: 3695 patients; LPD group: 4411 patients). Compared with LPD, RPD was associated with a lower conversion rate (RR, 0.56) and blood transfusion rate (RR, 0.49), as well as a higher number of harvested lymph nodes (MD, 2.15). There were no significant differences observed in 30-day readmission (RR, 1.02), 90-day mortality (RR, 1.01), overall morbidity (RR, 0.94), major complications (RR, 1.06), operative time (MD, -8.00 min), blood loss (MD, -19.37 mL), reoperation (RR, 0.95), bile leak (RR, 0.93), chylous leak (RR, 1.40), postoperative pancreatic fistula (RR, 1.06), delayed gastric emptying (RR, 0.92), wound infection (RR, 1.12), length of stay (MD, -0.32 days), and R0 resection (RR, 0.98) between the groups.</p><p><strong>Conclusions: </strong>Although LPD and RPD had similar surgical outcomes, RPD had the perioperative advantage over LPD in decreasing conversion rates and blood transfusion rates and increasing the number of lymph nodes harvested. Further randomized controlled trials evaluating the potential advantages of RPD over LPD are warranted.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2257-2272"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of an interpretable machine learning model to predict major adverse cardiovascular events after noncardiac surgery in geriatric patients: a prospective study.","authors":"Jiayu Yu, Xiran Peng, Ruihao Zhou, Tao Zhu, Xuechao Hao","doi":"10.1097/JS9.0000000000002203","DOIUrl":"10.1097/JS9.0000000000002203","url":null,"abstract":"<p><strong>Background: </strong>Major adverse cardiovascular events (MACEs) within 30 days following noncardiac surgery are prognostically relevant. Accurate prediction of risk and modifiable risk factors for postoperative MACEs is critical for surgical planning and patient outcomes. We aimed to develop and validate an accurate and easy-to-use machine learning model for predicting postoperative MACEs in geriatric patients undergoing noncardiac surgery.</p><p><strong>Materials and methods: </strong>The cohort study was conducted at an academic medical center between June 2019 and February 2023. The outcome was postoperative MACEs within 30 days after surgery. Significant predictors were selected using permutation-shuffling. Ten machine learning models were established and compared with the Revised Cardiac Risk Index (RCRI). The SHapley Additive exPlanations algorithm was used to interpret the models.</p><p><strong>Results: </strong>Of the 18,395 patients included, 354 (1.92%) experienced postoperative MACEs. Eighteen predictors were included in model development. The AutoGluon model outperformed other models and the RCRI with an AUROC of 0.884 (95% CI: 0.878-0.890), an accuracy of 0.976 (95% CI: 0.973-0.978), and a Brier score of 0.023 (95% CI: 0.020-0.026). In interpretability analyses, the hemoglobin level was the most important predictor. We identified the relationships between predictors and postoperative MACEs and interaction effects between some predictors. The AutoGluon model has been deployed as a web-based tool for further external validation ( https://huggingface.co/spaces/MDC2J/Predicting_postoperative_MACEs ).</p><p><strong>Conclusion: </strong>In this prospective study, the AutoGluon model could accurately predict MACEs after noncardiac surgery in geriatric patients, outperforming existing models and the RCRI. Subsequent interpretability analysis can provide insight into how our model works and help personalize surgical strategies.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"1939-1949"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iron deficiency promotes intra-leaflet hemorrhage-induced aortic valve calcification: an experimental study.","authors":"Huiruo Liu, Zeyu Yang, Hourong Sun, Zerui Wang, Feng Xu, Yuguo Chen, Chuanbao Li","doi":"10.1097/JS9.0000000000002208","DOIUrl":"10.1097/JS9.0000000000002208","url":null,"abstract":"<p><strong>Background: </strong>Intra-leaflet hemorrhage (IH) plays a well-recognized detrimental role in calcified aortic valve disease (CAVD). However, IH-induced fibro-osteogenic responses in valvular interstitial cells (VICs) appear to be triggered under specific pathological conditions. Iron deficiency (ID), a common co-morbidity in CAVD, may influence these responses. This study investigated the relationship between ID and pathological changes associated with CAVD, and its effects on IH-mediated fibro-osteogenic differentiation of VICs.</p><p><strong>Methods and results: </strong>Two independent studies were conducted, including 2495 patients in the discovery study and 34 in the validation study. Our data demonstrated that ID was associated with CAVD severity and progression, particularly in an age-dependent manner. Based on these clinical findings, immunofluorescence and Western blot analyses revealed that TFR1, a key iron import transporter, was significantly upregulated in human calcified aortic valves. Concurrently, iron accumulation was detected by Perl's staining in both calcific and non-calcific valve sections. In vitro , VICs cultured with human serum from ID patients showed red blood cell lysis-induced iron overload and fibro-calcific differentiation.</p><p><strong>Conclusions: </strong>ID triggers TFR1-mediated intracellular iron overload, leading to fibrosis and calcification in human VICs, thereby contributing to IH-mediated valve remodeling and calcification. These findings supported the potential role of monitoring and correcting ID to slow or prevent the progression of valvular calcification.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"1825-1835"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SNHG16 alleviates pulmonary ischemia-reperfusion injury by promoting the Warburg effect through regulating MTCH2 expression: experimental studies.","authors":"Wenyong Zhou, Shaohua Wang, Jichun Yang, Qi Shi, Nana Feng, Kaiheng Gao, Wan Posum, Mengkun Shi, Meng Xiang, Meng Shi","doi":"10.1097/JS9.0000000000002217","DOIUrl":"10.1097/JS9.0000000000002217","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary ischemia-reperfusion injury (PIRI) is a major cause of fatality post-lung transplantation. Though some long non-coding RNAs (lncRNAs) have been studied in acute lung injury (ALI), their effects on PIRI remain undefined. The present study aims to explore the underlying mechanism of small nucleolar RNA host gene 16 (SNHG16) in PIRI.</p><p><strong>Methods: </strong>PIR mouse and oxygen-glucose deprivation/reoxygenation (OGD/R) cell models were established. Exosomes were extracted from human pulmonary microvascular endothelial cells (HPMECs). Functional and rescue experiments were conducted in OGD/R-exposed HPMECs, OGD/R-exposed pulmonary alveolar epithelial type II cells (AECs), and I/R model mice. The relationships among SNHG16, miR-372-3p/miR-373-3p, and MTCH2 were also verified using dual luciferase reporter assay, RNA pull-down and RIP assay.</p><p><strong>Results: </strong>SNHG16 was downregulated in OGD/R-exposed HPMECs, and SNHG16 overexpression accelerated proliferation, angiogenesis, and ameliorated mitochondrial respiration in OGD/R-exposed HPMECs. HPMEC-derived exosomal SNHG16 suppressed OGD/R-induced type II AEC injury. SNHG16 ameliorated lung injury in PIR mice. Mechanistically, SNHG16 targeted and negatively regulated miR-372-3p and miR-373-3p expression, and MTCH2, a target gene of miR-372-3p/miR-373-3p. SNHG16 was found to upregulate MTCH2 expression not only in a miR-372-3p and miR-373-3p-dependent manner but also suppress ubiquitination induced MTCH2 degradation.</p><p><strong>Conclusions: </strong>Our findings revealed that SNHG16 overexpression suppressed OGD/R-induced HPMEC apoptosis by promoting Warburg effect, and HPMEC-derived exosomal SNHG16 alleviated PIRI through the miR-372-3p/miR-373-3p/MTCH2 axis, suggesting that SNHG16 as a therapeutic target for PIRI.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"1874-1890"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The efficacy of adjuvant chemotherapy for curative resected biliary tract cancers: a systematic review and network meta-analysis of randomized clinical trials.","authors":"Yishan Peng, Aijun Liang, Zhi Chen, Bin Yang, Wenke Yu, Jingduo Deng, Yu Fu, Yu Nie, Yuan Cheng","doi":"10.1097/JS9.0000000000002161","DOIUrl":"10.1097/JS9.0000000000002161","url":null,"abstract":"<p><strong>Background: </strong>Despite complete resection, the recurrence rate of biliary tract cancer (BTC) remains high, leading to poor prognosis. Postoperative adjuvant chemotherapy (ACT) following radical resection may substantially reduce the recurrence risk by eradicating micrometastatic lesions. However, the benefits of postoperative ACT and the optimal ACT strategy are still unclear for BTC. The objectives of this study are to evaluate the prognostic value of ACT and compare the effectiveness of different ACTs among BTC patients after curative resection.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted across PubMed, Cochrane Library, Web of Science, and EMBASE databases to identify randomized controlled trials (RCTs) comparing the benefits of ACT versus no intervention or other ACTs in BTC patients after curative resection. A random-effects network meta-analysis was performed to compare overall survival (OS) and relapse-free survival (RFS). The quality of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation framework.</p><p><strong>Results: </strong>Eight RCTs comprising 1803 patients were included in the meta-analysis. ACT was associated with significant improvements in 5-year all-cause mortality [four RCTs, hazard rate (HR) 0.93; 95% confidence interval (CI), 0.87-1.00, marginally significant; low-certainty evidence], RFS (five RCTs, HR 0.87; 95% CI, 0.78-0.98; moderate-certainty evidence), and OS (7 studies, HR 0.85; 95% CI, 0.75-0.96; low-certainty evidence) compared with observation. ACT had significantly better survival benefits on patients with negative margins (R0), lymph node-positive (N+), and tumor node metastasis classification (TNM) stage I/II ( P < 0.05). Further network meta-analysis demonstrated that fluorouracil-based ACT was significantly inferior to gemcitabine-based ACT (HR 1.20; 95% CI, 1.10-1.25) in improving RFS. However, both were superior to observation ( P < 0.05). No statistical difference in OS was observed between gemcitabine-based and fluorouracil-based chemotherapy (HR 1.00; 95% CI, 0.86-1.20). In subgroup analysis, fluorouracil-based ACT but not gemcitabine-based ACT achieved significantly better OS benefits on patients with N+ (HR 0.67; 95% CI, 0.52-0.86) and R0 (HR 0.69; 95% CI, 0.54-0.88).</p><p><strong>Conclusion: </strong>Compared with observation, ACT should be routinely recommended to improve survival outcomes in BTC patients after curative resection, especially for those with R0, N+, and TNM stage I/II. Gemcitabine-based ACT performed better than other chemotherapies in improving RFS. This network meta-analysis provides precise information for determining the best adjuvant treatment for resected BTC. Further thorough and high-quality RCTs are needed.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2182-2194"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tracking adipose-derived stem cell exosomes applied in a mouse crush injury model: insights from fluorescent labeling and spatial transcriptomics - an experimental study.","authors":"Cheng-Shyuan Rau, Shao-Chun Wu, Pao-Jen Kuo, Chia-Wei Lin, Tsu-Hsiang Lu, Yi-Chan Wu, Chia-Wen Tsai, Ching-Hua Hsieh","doi":"10.1097/JS9.0000000000002166","DOIUrl":"10.1097/JS9.0000000000002166","url":null,"abstract":"<p><p>Adipose-derived stem cell exosomes (ADSC-exos) are promising for nerve regeneration; however, their precise mechanisms remain unclear. This study employed fluorescent labeling and spatial transcriptomics to track the effects of ADSC-exos on crushed sciatic nerves in mice. Labeled exosomes were detected in spinal neurons and proximal nerve segments after application. Spatial transcriptomics revealed significant changes in gene expression, with an upregulation of neurons and Schwann cells and the downregulation of oligodendrocytes. The key pathways affected were prosaposin, pleiotrophin, fibroblast growth factor, secreted phosphoprotein 1, SLIT and NTRK-like family, member, vascular endothelial growth factor, and growth arrest-specific protein. ADSC-exo treatment enhanced cell-cell interactions, particularly between Schwann cells and astrocytes, thereby promoting a regenerative environment. Gene ontology analysis suggested improvements in metabolic activity, cell communication, and structural support. This study highlights the complex interplay between multiple cell types and signaling pathways involved in the nerve regeneration response to ADSC-exos. This comprehensive approach offers new perspectives on the role of ADSC-exos in nerve regeneration and paves the way for advanced regenerative strategies for peripheral nerve injuries.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"1860-1873"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alterations of oscillatory activity and cognitive function after aneurysmal subarachnoid hemorrhage.","authors":"Peng Liu, Chuanliang Han, Tongyu Zhang, Yueqiao Xu, Kun Yang, Yuxia Li, Zhennan Ye, Changming Wang, Hongqi Zhang","doi":"10.1097/JS9.0000000000002190","DOIUrl":"10.1097/JS9.0000000000002190","url":null,"abstract":"<p><strong>Background: </strong>Aneurysmal subarachnoid hemorrhage (aSAH) can lead to cognitive impairment (CI), but underlying neural mechanisms remain to be elucidated.</p><p><strong>Materials and methods: </strong>To predict long-term CI after aSAH, resting electroencephalography (EEG) was measured in 112 patients hospitalized with a diagnosis of aSAH ( n = 66) or unruptured intracranial aneurysms (controls) ( n = 46). A neuropsychological battery was administered 8-24 months after discharge.</p><p><strong>Results: </strong>Power spectrum analysis in the parietal-occipital lobe showed significantly higher power theta vs. alpha oscillations in patients with CI after aSAH. The power of theta and alpha oscillations were significantly correlated with multiple cognitive scale scores on the neuropsychological battery. A neural model was established, which showed that connectivity between inhibitory and excitatory neurons in neural circuits contributed to changes in theta and alpha oscillations and CI in aSAH.</p><p><strong>Conclusion: </strong>The data collection, analysis, and computational model established in this study can serve as a new paradigm for other clinical studies investigating CI.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"1919-1928"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Probiotics prevent pegylated liposomal doxorubicin-associated hand-foot syndrome and oral mucositis of breast cancer patients following surgery and chemotherapy: a randomized placebo-controlled trial.","authors":"Zhang Juan, Jie Chen, Boni Ding, Liang Yongping, Haifeng Cai, Hui Chen, Ling Wang, Yuan Le, Jingcheng Shi, Yuhui Wu, Daqing Ma, Wen Ouyang, Yong Cheng, Jianbin Tong","doi":"10.1097/JS9.0000000000002147","DOIUrl":"10.1097/JS9.0000000000002147","url":null,"abstract":"<p><strong>Background: </strong>Hand-foot syndrome (HFS) and oral mucositis (OM) are common adverse events during cancer chemotherapy and can significantly decrease patients' quality of life and chemotherapy adaptation, however, prevention strategies of these complications yet to be established.</p><p><strong>Methods: </strong>Patients with stages I-III breast cancer, who had surgery and needed pegylated liposomal doxorubicin (PLD)-based adjuvant chemotherapy were screened, recruited and randomly assigned to receive either probiotics or placebo (three capsules, twice/day) treatment during the course of chemotherapy from November 2019 to August 2020. The incidence and severity of PLD related HFS and OM, and patients' quality of life were assessed. Their plasma biomarkers, metabolites and fecal microbiota compositions were measured. And the results were further verified in animal experiments.</p><p><strong>Results: </strong>Probiotics supplement during PLD treatment significantly decreased the incidence and the severity of HFS and OM ( P < 0.001), improved patients' life quality ( P < 0.001), increased the relative abundance of intestinal Enterococcus ( P = 0.025) and mitigated the changes of seven plasma metabolites. Among these metabolites, the changes of p-Mentha-1,8-dien-7-ol (MDO) ( B = - 0.441, P = 0.02) and L-arginine ( B = - 0.586, P = 0.002) were negatively correlated with the occurrence of severe HFS and OM. MDO can partly reproduce the preventive effects of probiotics on PLD-related skin cell proliferating inhibition, DNA damage, and local inflammation in rats.</p><p><strong>Conclusion: </strong>Probiotics supplement during PLD-based chemotherapy prevents the incidence and severity of HFS and OM, which may be associated with modulating plasma metabolites including the MDO.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2018-2030"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}