Journal of neurosurgical sciences最新文献

{"title":"Multimodal management of pediatric brain arteriovenous malformations: single-center experience from a retrospective observational study.","authors":"Giuseppe Mirone, Giulia Meccariello, Nicola Onorini, Domenico Cicala, Mario Muto, Eugenio Covelli, Giuseppe Cinalli","doi":"10.23736/S0390-5616.26.06556-2","DOIUrl":"10.23736/S0390-5616.26.06556-2","url":null,"abstract":"<p><strong>Background: </strong>Intracranial arteriovenous malformations (AVMs) are a major cause of intracranial hemorrhage (ICH) in children, often leading to significant neurological deficits or mortality. The primary aim of this study was to analyze the management strategies and long-term outcomes of pediatric AVMs treated at Santobono-Pausilipon Children's Hospital over the past 15 years with a particular focus on hemorrhagic presentation.</p><p><strong>Methods: </strong>A retrospective review was conducted on pediatric patients (0-18 years) diagnosed with intracranial AVMs between July 2008 and December 2024. Data on demographics, clinical presentation, imaging findings, Spetzler-Martin and Supplemented Spetzler-Martin grading, treatment modalities, complications, and outcomes were collected. Treatment approaches included microsurgical resection, endovascular embolization, stereotactic radiosurgery (SRS), and multimodal management were evaluated.</p><p><strong>Results: </strong>A total of 48 pediatric AVM cases were identified (24 males, 24 females; mean age: 8.8 years). The majority (N.=41, 85.4%)) presented with intracranial hemorrhage. Treatment strategies included microsurgical resection (17 cases), embolization (6 cases), SRS (9 cases), and multimodal therapy (14 cases). Mean follow-up was 5 years. Residual AVMs were detected in 13% of cases, with three rebleeding events. The postoperative modified Rankin Scale (mRS) showed favorable outcomes (mRS 0-2) in 37 patients. One patient died due to major hemorrhage.</p><p><strong>Conclusions: </strong>Pediatric AVMs exhibit diverse clinical presentations and require individualized management strategies. While surgical resection remains the most definitive treatment, multimodal approaches may be necessary for high-grade or deep-seated AVMs. Long-term follow-up is crucial due to the risk of AVM recurrence and rebleeding. Advancements in molecular and genetic research may further refine therapeutic strategies for pediatric AVMs in the future.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"279-288"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592686","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 weak MGMT promoter methylation on the prognosis of patients with newly diagnosed glioblastoma.","authors":"Bujung Hong, Hind Chaib, Gonzalo Moros, Yuriy Tsoy, Sonia Ziegler, Hans E Heissler, Christian Mawrin, Ehab Shiban","doi":"10.23736/S0390-5616.26.06772-X","DOIUrl":"https://doi.org/10.23736/S0390-5616.26.06772-X","url":null,"abstract":"<p><strong>Background: </strong>In most cases, routine neuropathological analysis can clearly distinguish between methylated and unmethylated MGMT promoters in glioblastoma (GBM). However, some GBMs display weak MGMT promoter methylation. This study aimed to evaluate its impact on disease progression and survival compared with fully methylated and unmethylated cases.</p><p><strong>Methods: </strong>A quantitative analysis of MGMT promoter methylation was performed on 140 of 190 samples from a cohort of adult patients with newly diagnosed GBM. The MGMT promoter was stratified into three subgroups based on methylation status: unmethylated, weakly methylated (9-28%), and methylated (29-100%). These cut-off values were selected based on previously published data demonstrating significant differences in progression-free survival (PFS) and overall survival (OS) among patients with these categories. Clinical characteristics, treatment regimens, and survival outcomes were analyzed and compared. Cox proportional hazards regression was used to evaluate the impact of MGMT methylation status on progression-free interval (PFI) and overall survival (OS).</p><p><strong>Results: </strong>The MGMT promoter was unmethylated in 57 (40.7%) samples, methylated in 66 (47.1%) samples, and weakly methylated in 17 (12.1%) samples. Compared to patients with methylated and unmethylated MGMT promoters, the PFI of patients with weak MGMT methylation was comparable (P=0.53) and the OS was slightly longer (P=0.08). After stratification following chemoradiotherapy consisting of TMZ, patients with weakly methylated MGMT have a longer PFI. The Cox proportional hazards regression model revealed that a weakly methylated MGMT promoter was a significant risk factor for longer OS (P=0.02), while older age remained an unfavorable prognostic factor for survival (P<0.001).</p><p><strong>Conclusions: </strong>Weak MGMT promoter methylation may offer clinical benefits comparable to full methylation, including longer PFI and improved OS compared to unmethylated cases. This positive effect on PFI appears more pronounced in patients receiving concurrent chemoradiotherapy with TMZ. Advanced age continues to be associated with a less favorable prognosis.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148302012","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":"Pressure under the knife: embracing equanimity in neurosurgery.","authors":"Saarang Patel, Ryan Holland, Ryan Khanna","doi":"10.23736/S0390-5616.26.06843-8","DOIUrl":"https://doi.org/10.23736/S0390-5616.26.06843-8","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251928","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":"Normal pressure hydrocephalus as a mechanobiological disorder.","authors":"Leonardo Fiori","doi":"10.23736/S0390-5616.26.06807-4","DOIUrl":"https://doi.org/10.23736/S0390-5616.26.06807-4","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148150031","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":"Intracranial complications of sinogenic and otogenic infections in children: single center study in a global increasing trend.","authors":"Vittorio Ricciuti, Davide Luglietto, Alessandro DE Benedictis, Liliana Meletti, Alessio Iacoangeli, Sara Rizzi, Laura Cursi, Carlo Gandolfo, Giovanni Cristalli, Carlo E Marras","doi":"10.23736/S0390-5616.25.06649-4","DOIUrl":"10.23736/S0390-5616.25.06649-4","url":null,"abstract":"<p><strong>Background: </strong>Recent studies have documented a rising incidence of intracranial complications of sinusitis and otitis (ICSO) in the post-COVID-19 era, particularly in pediatric patients. The aim of this study is to analyze this trend in our institution and compare it with recent literature, with a specific focus on decompressive craniectomy as critical part of the surgical management.</p><p><strong>Methods: </strong>We retrospectively reviewed all patients under 18 years of age admitted to Bambino Gesù Children's Hospital with a discharge diagnosis of ICSO, between January 2017 and December 2024. We analyzed patients' demographic data, pathogen characteristics, type of primary infection and intracranial complications, and signs and symptoms at presentation. Management of the infection and cerebral venous sinus thrombosis (CVST) rate were also reported, along with clinical and radiological outcomes.</p><p><strong>Results: </strong>A total of 26 patients were included with an estimated increase of 1.07 patients per year (β=1.07, 95% CI [0.23, 1.91], P=0.018). 3 patients were managed exclusively with antibiotic therapy, 2 underwent sinus endoscopic surgical treatment, 11 underwent neurosurgical intervention, and 10 required a combined approach. Six patients underwent decompressive craniectomy. Venous sinus thrombosis was identified in 10 patients. Overall, 19 patients had a clinical complete recovery, while 5 presented residual deficits at follow-up. 2 patients had a fatal progression of the infection.</p><p><strong>Conclusions: </strong>This single-center study highlights a significant increase in ICSO in the post-COVID-19 era in the pediatric population, with a high proportion of venous sinus thrombosis (40%) and decompressive craniectomy (29%). High vigilance for ICSO in children, particularly in the context of evolving post-pandemic infectious disease patterns is recommended.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"216-224"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284408","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":"Predicting postoperative length of stay: a feature selection approach to predictive modeling in lumbar fusion surgery.","authors":"Aman Singh, Rohin Singh, Jag Lally, George Kassis, Omar Sbaih, Kevin Yoon, Suyash Sau, Taylor Furst, Gabrielle Santangelo, Jonathan J Stone","doi":"10.23736/S0390-5616.25.06604-4","DOIUrl":"10.23736/S0390-5616.25.06604-4","url":null,"abstract":"<p><strong>Background: </strong>Predictive modeling has the potential to improve preoperative planning and resource allocation in lumbar fusion surgery. This study aimed to identify the 20 most important variables for predicting prolonged postoperative length of stay (pLOS) using machine learning (ML).</p><p><strong>Methods: </strong>The ACS-NSQIP database was queried for lumbar fusion procedures performed between 2012 and 2022, including ALIF, PlatIF, PLIF, and combined PLIF+PlatIF. Variable selection was performed using MUVR and Boruta, followed by hierarchical clustering and 5-fold cross-validation to ensure feature robustness. The 20 selected features were used to train multiple ML models, including tree-based classifiers (Random Forest, XGBoost, CatBoost, LightGBM), support vector classifiers, neural networks, ensemble methods, and logistic regression.</p><p><strong>Results: </strong>A total of 114,892 patients were included. Eleven patient-specific and nine procedural variables were identified as most predictive of prolonged pLOS. Among patient factors, dialysis, congestive heart failure, and bleeding disorders were strongest predictors. Among procedural factors, osteotomy, billing of additional fusion codes, and longer operation time had the greatest impact. The neural network achieved the highest accuracy (71.2%), recall (79.4%), and F1-score (73.8%), though all models performed similarly, with minimal variation in classification metrics.</p><p><strong>Conclusions: </strong>These findings underscore that model choice plays a limited role once optimal features are selected - feature selection was the most critical determinant of predictive performance.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"186-195"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774717","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":"Ventriculo-atrial shunt and European regulations: a delicate balance.","authors":"Luca Massimi, Marco Obersnel, Paolo Frassanito, Federico Bianchi, Gianpiero Tamburrini","doi":"10.23736/S0390-5616.25.06465-3","DOIUrl":"10.23736/S0390-5616.25.06465-3","url":null,"abstract":"<p><strong>Background: </strong>European regulations on medical devices have been introduced to improve medical standards. However, these changes are leading to the transient lack of medical tools with possible disadvantages. Herein, the problem is addressed for the first time in neurosurgery with regards to ventriculo-atrial shunt (VAS).</p><p><strong>Methods: </strong>Children undergoing VAS in the 2020-2022 period at a single Institution were enrolled. Patients receiving VAS with Pudenz cardiac catheter (distal slit \"valves\") were assigned to group A (2020-2021) while those with VAS harboring proximal adjustable valve to group B (2021-2022, Pudenz no more available). The complications leading to shunt malfunction within 2 years from VAS were analyzed.</p><p><strong>Results: </strong>Twenty-four children belonged to group A (M/F ratio: 2.4; mean age: 42.5 months) and 18 to group B (MF/ratio: 1.8, mean age: 48.1 months). Statistically significant differences were found about: 1) patients needing shunt revision: 7 cases (29%) in group A vs. 11 cases (61%) in group B; 2) number of shunt revisions: 8 in group A vs. 16 in group B; 3) number of children with mechanical complications: 2 (8.3%) in group A vs. 7 (39%) in group B; 4) number of mechanical complications: 2 (group A) vs. 9 (group B). No differences in other complications or placement-to-revision time were detected.</p><p><strong>Conclusions: </strong>The lack of simple surgical tools (Pudenz catheter) may make VAS more prone to mechanical complications. Prospective and multicenter trials are needed to produce scientific evidence. In the meantime, a multidisciplinary discussion on the European regulation (including Doctors and Manufacturers) is welcome.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"179-185"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150686","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":"Targeting EGFR in glioblastoma: lessons from a disappointing journey. A systematic review.","authors":"Ali Berro, Ahmad Assi, Sarah Samhat, Grace Sabra, Rita Haddad, Yara Gebran, Ronald Moussa","doi":"10.23736/S0390-5616.26.06708-1","DOIUrl":"10.23736/S0390-5616.26.06708-1","url":null,"abstract":"<p><strong>Background: </strong>This review aims to review the efficacy and toxicity of anti-epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors in the management of glioblastoma.</p><p><strong>Methods: </strong>A systematic review was completed utilizing PubMed, Cochrane, and Embase databases up to February 2025. Boolean operators and the MeSH term \"glioma\" were used, along with relevant keywords related to EGFR.</p><p><strong>Results: </strong>First- and second-generation EGFR-focused TKIs performed poorly in patients with GBM. The use of erlotinib in combination with radiotherapy, alkylating agents, and anti-angiogenic agents yielded the best outcomes in patients with newly diagnosed GBM.</p><p><strong>Conclusions: </strong>EGFR-focused TKIs were largely disappointing as a treatment for GBM. Longstanding issues, including treatment resistance, tumor heterogeneity, and blood-brain barrier penetration persist. Future efforts must focus on tackling these issues, and prioritizing patient selection via biomarkers.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"233-241"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512800","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":"Large language models in artificial intelligence to answer patient questions in spine surgery: an evaluation of current evidence.","authors":"Janam Patel, Zayaan Tirmizi, Ayesha A Waheed, Serhat Aydin, Avi A Gajjar, Najib Muhammad, Andrew Legarreta, Qazi Zeeshan, D Kojo Hamilton, Nitin Agarwal, Hansen Deng","doi":"10.23736/S0390-5616.26.06678-6","DOIUrl":"10.23736/S0390-5616.26.06678-6","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) are increasingly being explored in healthcare, particularly for enhancing patient education. In spine surgery, LLMs have the potential to enhance communication and support patients through perioperative care. However, concerns remain regarding the accuracy, readability, and overall reliability of these tools in delivering patient-facing information. This review aimed to understand the current use of LLMs in answering patient questions in spine surgery.</p><p><strong>Methods: </strong>A structured search of PubMed and Google Scholar was conducted using terms focused on LLMs and neurosurgery. Studies were only included if they tested LLMs' ability in answering patient questions related to spine surgery. Exclusion criteria included non-peer-reviewed articles, studies that did not evaluate chatbot performance, or those using LLMs for non-educational purposes.</p><p><strong>Results: </strong>LLMs were tested across a variety of spine-related topics, including scoliosis, lumbar and cervical fusion, endoscopic procedures, and spinal cord stimulation. Studies consistently reported moderate to high accuracy ratings. Readability scores remained a limitation, with most responses written at a college reading level. Empathy and clarity varied by model and condition, with some studies showing improved ratings when assessed by non-medical reviewers. Methodological variability across studies introduced inconsistencies and limited comparability.</p><p><strong>Conclusions: </strong>LLMs show promising utility for patient education in spine surgery for addressing frequently asked questions. However, challenges in readability, accuracy, and standardization limit their current clinical adoption. Moving forward, studies must incorporate standardized evaluation tools, address high rate of content hallucination, and focus on chatbot performance in personalized scenarios. Cross-disciplinary collaboration is essential to ensure safe, accessible integration into neurosurgical care pathways.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"225-232"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147593049","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":"Machine learning-based models using preoperative imaging and clinical data to predict intraoperative rebleeding and functional recovery in intracerebral hemorrhage patients: a multicenter study.","authors":"Xinggang Xiang, Zhen Ma, Lin Lin, Chun Fang, Rui Zhang, Jingliang Gu, Ziyi Zhai, Ting Hui","doi":"10.23736/S0390-5616.25.06664-0","DOIUrl":"10.23736/S0390-5616.25.06664-0","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous intracerebral hemorrhage (ICH) is associated with high mortality and disability. This study aimed to develop and validate machine learning models based on preoperative multimodal data to predict the risk of intraoperative rebleeding (IOR) and postoperative functional recovery in ICH patients, thereby providing support for precision treatment decisions.</p><p><strong>Methods: </strong>This multicenter prospective cohort study included 498 primary ICH patients who underwent surgical treatment at three tertiary hospitals in China between January 2018 and December 2023. Preoperative clinical characteristics, laboratory tests, and imaging parameters were collected. The primary endpoint was IOR (defined as obvious arterial bleeding requiring additional hemostatic measures during surgery, or residual/new hematoma increased by ≥5 mL on CT within 24 hours after surgery compared to preoperative assessment). The secondary endpoint was good functional outcome (modified Rankin Scale [mRS] ≤2) at 6 months postoperatively. Machine learning algorithms were used to construct prediction models, which were evaluated through temporal validation and external multicenter validation cohorts.</p><p><strong>Results: </strong>Among the included patients, the incidence of IOR was 14.7% (73/498), and the rate of good outcome at 6 months was 42.6% (212/498). After rigorous cross-validation and hyperparameter optimization, the deep neural network model performed best in predicting IOR (AUC 0.892, 95%CI: 0.851-0.933), with accuracy of 83.7%, sensitivity of 84.6%, and specificity of 83.5%. The XGBoost model was optimal for predicting functional recovery (AUC 0.875, 95%CI: 0.831-0.919), with accuracy of 81.9%, sensitivity of 82.1%, and specificity of 81.8%. In the external validation cohort (N.=156), the two models achieved AUCs of 0.842 (95%CI: 0.768-0.916) and 0.831 (95%CI: 0.758-0.904), respectively. Multivariate analysis showed that hematoma volume (OR=1.35, 95%CI: 1.21-1.51, per 10 mL increase), admission INR (OR=3.17, 95%CI: 2.04-4.93, >1.4 vs. ≤1.4), midline shift (OR=1.28, 95%CI: 1.13-1.44, per 1 mm increase), and preoperative platelet count (OR=0.83, 95%CI: 0.76-0.91, per decrease of 20×10⁹/L) were independent risk factors for IOR. Decision curve analysis demonstrated that machine learning models provided higher net clinical benefit than traditional ICH and FUNC scores.</p><p><strong>Conclusions: </strong>Machine learning prediction models validated across multiple centers can accurately assess the risk of IOR and postoperative functional recovery in ICH patients, thereby guiding individualized treatment decisions and potentially improving patient outcomes.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"196-215"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147486301","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}