{"title":"Early Electrophysiological Study of CC7 Transfer to Median Nerve and Deep Branch of Ulnar Nerve by Medial Antebrachial Cutaneous Nerve.","authors":"Yuzhou Liu, Hu Yu, Jingbo Liu, Jie Lao","doi":"10.1097/GOX.0000000000007066","DOIUrl":"10.1097/GOX.0000000000007066","url":null,"abstract":"<p><strong>Background: </strong>Due to the possibility of intrinsic muscle recovery, we modified the traditional contralateral cervical seventh (CC7) nerve transfer to repair both the median nerve and deep branch of the ulnar nerve (DBUN) for patients with total brachial plexus avulsion (TBPA).</p><p><strong>Methods: </strong>A retrospective comparative study of different CC7 transfers for patients with TBPA was carried out. The modified group (20 patients) had CC7 transfer to the median nerve and DBUN by ulnar nerve with vascular pedicle and medial antebrachial cutaneous nerve. The control group (20 patients) had traditional CC7 transfer to median nerve by ulnar nerve with vascular pedicle.</p><p><strong>Results: </strong>Motor unit potentials (MUPs) could be recorded in the abductor digiti minimi (ADM) and dorsal interosseous muscle in 5 and 2 patients, respectively, in the modified group, whereas nobody had MUP in the ADM or dorsal interosseous muscle in the control group. There was significant difference between the 2 groups in the recovery of MUPs in ADM. As for median nerve recovery, there were no statistical differences in the positive rates of MUPs in abductor pollicis brevis. No significant differences of compound motor action potential existed in flexor digitorum profundus of index finger or flexor carpi radialis between the 2 groups.</p><p><strong>Conclusions: </strong>From the perspective of electrophysiology, it was possible to regenerate intrinsic muscles using CC7 transfer to the median nerve and DBUN by pedicled ulnar nerve and medial antebrachial cutaneous nerve in patients with TBPA while not affecting the recovery of the median nerve.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 9","pages":"e7066"},"PeriodicalIF":1.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150342","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}
Sobia Yasmeen, Obaid Ur Rahman, Muhammad Imran Khan, Rabia Anwar, Hassan Tahir
{"title":"Continuous Through-the-lumen Microvascular Anastomosis: A Retrospective Review of a Modified Technique.","authors":"Sobia Yasmeen, Obaid Ur Rahman, Muhammad Imran Khan, Rabia Anwar, Hassan Tahir","doi":"10.1097/GOX.0000000000007128","DOIUrl":"10.1097/GOX.0000000000007128","url":null,"abstract":"<p><strong>Background: </strong>The debate between continuous and interrupted sutures for microvascular anastomosis has long persisted, with broader acceptance of the interrupted technique. Although studies show comparable outcomes, continuous suturing remains underused due to concerns of technical complexity, anastomotic constriction, and patency loss. We present a simplified and effective continuous technique that addresses these concerns.</p><p><strong>Methods: </strong>This 5-year retrospective study included all elective free tissue transfers performed using the described continuous suture technique. Trauma-related replantation and revascularization cases were excluded. Patient records were reviewed for demographics, flap types, anastomosis configuration and timing, reexplorations, complications, and outcomes.</p><p><strong>Results: </strong>The technique was performed in 785 patients, encompassing 2346 microvascular anastomoses (794 arterial and 1552 venous). End-to-end anastomoses were done in 633 arteries and 867 veins, and end-to-side anastomoses in 161 arteries and 685 veins. Flap types included anterolateral thigh (n = 384), radial forearm (n = 220), fibula (n = 145), latissimus dorsi (n = 29), deep inferior epigastric artery (n = 2), ulnar forearm (n = 3), and toe transfers (n = 2). Mean arterial and venous anastomosis times were 7.5 and 10 minutes, respectively. All anastomoses achieved 100% immediate patency. There were 41 reexplorations, mostly for venous issues, with 28 flap failures. The overall flap success rate was 96.43%.</p><p><strong>Conclusions: </strong>This modified continuous technique enables posterior wall repair through the vessel lumen without flipping, minimizing manipulation and reducing operative time. It offers a reproducible, efficient approach for both arterial and venous anastomoses.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 9","pages":"e7128"},"PeriodicalIF":1.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150410","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":"Analysis of Dermal Thickness Across 10 Areas and Injection Depth After Polynucleotide Injection Using Rejumate Automatic 0.8-mm 9-pin Injector on the Face Using 33-MHz Sonography.","authors":"Jong Seo Kim, Suwanchinda Atchima","doi":"10.1097/GOX.0000000000007121","DOIUrl":"10.1097/GOX.0000000000007121","url":null,"abstract":"<p><strong>Background: </strong>Automated injection devices are becoming essential tools in aesthetic medicine, offering precision and consistency in treatments such as polynucleotide (PN) injections for skin rejuvenation. This study aimed to analyze the dermal thickness across facial regions and evaluate the consistency of injection depth achieved with the Rejumate automatic injector.</p><p><strong>Methods: </strong>A total of 31 patients (average age 48.2 y; 4 men and 27 women) underwent dermal thickness measurements using high-resolution 33-MHz ultrasound in 11 facial regions, including the forehead, temple, orbital rim, lower eyelid, malar, anterior cheek, lateral cheek, posterior cheek, jawline, and chin. Each patient then received a standardized 2-mL PN injection using the Rejumate injector with a 0.8-mm needle across 317 individual points. Injection depth, distribution, and consistency were measured and analyzed.</p><p><strong>Results: </strong>The average dermal thickness across regions ranged from 0.53 (lower eyelid) to 1.18 mm (temple and posterior cheek). The Rejumate injector demonstrated a high degree of consistency, achieving an average injection depth of 0.55 mm (SD = 0.13 mm), with a median depth of 0.54 mm. The depth range (0.29-0.99 mm) and interquartile range (0.17 mm) indicated controlled depth with minimal variability.</p><p><strong>Conclusions: </strong>The Rejumate automatic injector reliably delivers PN at a controlled depth, showing minimal variability across injections. This precision supports improved safety and efficacy in PN delivery, providing a valuable reference for clinical application in aesthetic treatments. Given the anatomical differences in dermal thickness across facial regions, this standardized approach may optimize outcomes and increase patient satisfaction.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 9","pages":"e7121"},"PeriodicalIF":1.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150368","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":"Strategies for Reducing Surgical Site Infections After Oral Cancer Resection and Free-flap Reconstruction.","authors":"Mikumo Nakakawaji, Ryota Nakamura, Aoi Oyama, Kosuke Mogi, Shunya Nabetani, Hiroto Uchikoshi, Seiko Okumura, Nobuhiro Hanai, Keisuke Takanari","doi":"10.1097/GOX.0000000000007101","DOIUrl":"10.1097/GOX.0000000000007101","url":null,"abstract":"<p><strong>Background: </strong>Despite numerous efforts to reduce surgical site infection (SSI) in patients undergoing head and neck reconstruction, infection rates have remained high. Recently, we introduced an original perioperative wound management protocol that includes 3 steps: intraoperative irrigation of the surgical field with iodine saline, compression of the dead space in the postoperative period, and oral care by reconstructive surgeons. Here we described our management protocol and reported changes in SSI rates and associated outcomes.</p><p><strong>Methods: </strong>This study included 120 consecutive patients who underwent resection and free-flap reconstruction for oral cancers at our institution from 2020 to 2022. The study compared cases with perioperative wound management without our protocol (control group, n = 60) and those with our protocol (study group, n = 60). Factors influencing the infection rates were statistically analyzed.</p><p><strong>Results: </strong>No statistical differences were observed between the 2 groups in patient characteristics. In the univariate logistic regression analysis, perioperative wound management with our protocol (<i>P</i> = 0.012, odds ratio [OR] = 0.350) and age (<i>P</i> = 0.024, OR = 0.963) were significantly associated with infection. In the multivariate analysis, only perioperative wound management with our protocol was significantly correlated with SSI (<i>P</i> = 0.015, OR = 0.353). There was a significant difference in the days nil by mouth (<i>P</i> = 0.014) and the length of hospitalization (<i>P</i> = 0.003) between the groups.</p><p><strong>Conclusions: </strong>Our perioperative protocol seemed to be effective in preventing postoperative SSIs, reducing the days of nil by mouth, and shortening hospital stay after oral cancer resection and reconstruction.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 9","pages":"e7101"},"PeriodicalIF":1.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150400","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}
Julia M Maxey, Fiona R Fragomen, Kyle Chepla, James R Gatherwright
{"title":"Novel Split Latissimus Dorsi Myocutaneous Flap After High-velocity Ballistic Injury With Functional Deficit: Retrospective Case Series.","authors":"Julia M Maxey, Fiona R Fragomen, Kyle Chepla, James R Gatherwright","doi":"10.1097/GOX.0000000000007137","DOIUrl":"10.1097/GOX.0000000000007137","url":null,"abstract":"<p><p>Severe trauma often results in structural and functional impairments, necessitating advanced surgical interventions to restore mobility and function, often in the setting of soft tissue defects. Myocutaneous free flap transfer serves as an excellent choice for extremity trauma. In this case series, we detailed the implementation of the split latissimus dorsi flap (s-LDF) as a myocutaneous flap to address complex motor functional deficits from gunshot wound injuries. The following 2 novel cases document the s-LDF for improved motor functionality capabilities after gunshot wounds in the lower extremity and upper extremity. In these patients, s-LDF was able to restore strength and motor function comparable to other transfers with the aforementioned benefits. The successful application of the s-LDF as a myocutaneous flap in these 2 cases provides an additional adjunct to the functional muscle transfer armamentarium.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 9","pages":"e7137"},"PeriodicalIF":1.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150415","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}
Atiyeh Bishara, Rawad Chalhoub, Edwin Chrabieh, Fayez Daoud, George Greige, Tarek El Hachem, Saif Emsieh
{"title":"Arm Contouring in Patients With Massive Weight Loss: A Literature Review.","authors":"Atiyeh Bishara, Rawad Chalhoub, Edwin Chrabieh, Fayez Daoud, George Greige, Tarek El Hachem, Saif Emsieh","doi":"10.1097/GOX.0000000000007126","DOIUrl":"10.1097/GOX.0000000000007126","url":null,"abstract":"<p><strong>Background: </strong>A wide variety of brachioplasty approaches and modifications have been described to make the procedure safer and more appealing to patients and surgeons alike. There is, however, no consensus on the most appropriate surgical approach. The current report aimed at identifying the technique that yields optimal aesthetic outcomes and scar quality associated with highest patient satisfaction and lowest scar visibility and complication rates, in the growing population of patients with massive weight loss.</p><p><strong>Methods: </strong>A PICO PubMed, Embase, and Web of Science literature search was conducted to identify clinical cohort studies published since 1974 about post-bariatric patients undergoing brachioplasty.</p><p><strong>Results: </strong>Fifteen studies satisfied the inclusion criteria and were retrieved for review. Two main methods for excess skin and fat removal, en bloc sharp excision or liposuction-assisted brachioplasty, and 2 final scar placements, medial and posteromedial, with some variations, together with various axillary scars, have been reported. Higher overall complication rate was associated with excisional brachioplasty. Two main scar placements have also been reported: primarily medial, with various extensions to excise additional tissues in the axilla or the elbow region, and posteromedial.</p><p><strong>Conclusions: </strong>Each described technique has advantages and disadvantages. Although quantitative analysis was not possible to conduct, it seems logical that combining advantages of liposuction-assisted brachioplasty with reduced posteromedial scar visibility, in addition to a stepwise \"cut-as-you-go\" approach, would be most favored, allowing safe procedure execution with optimal aesthetic outcomes and lowest complication rates.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 9","pages":"e7126"},"PeriodicalIF":1.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150401","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":"Congenital Lateral Upper Lip Sinus: A Review of the Literature.","authors":"Nardin Elias, Noam Armon, Mor Rittblat","doi":"10.1097/GOX.0000000000007108","DOIUrl":"10.1097/GOX.0000000000007108","url":null,"abstract":"<p><strong>Background: </strong>Congenital lateral upper lip sinus is an exceptionally rare developmental anomaly, with few cases reported in the literature. It is characterized by the presence of a sinus tract located on the lateral aspect of the upper lip, which may lead to intermittent discharge and cosmetic concerns. Surgical excision is the standard treatment to prevent recurrence and restore lip contour.</p><p><strong>Methods: </strong>We report a case of a 1-year-old male infant with a congenital lateral upper lip sinus, present since birth and associated with intermittent clear discharge. Clinical evaluation and ultrasonography were performed to assess the extent of the sinus tract. Surgical excision was undertaken under general anesthesia using a fine metal probe to delineate the tract and aid in dissection. The sinus tract was removed completely, and layered closure of the wound was performed.</p><p><strong>Results: </strong>The sinus tract measured approximately 2 cm in length and extended through the orbicularis oris muscle without involving deeper structures. Histopathologic analysis confirmed a tract lined by a stratified squamous epithelium. Postoperative recovery was uneventful, with no evidence of infection or recurrence at the 1-year follow-up. The aesthetic outcome was satisfactory with minimal scarring.</p><p><strong>Conclusions: </strong>Although rare, congenital lateral upper lip sinus should be considered in the differential diagnosis of lip anomalies in infants. Early surgical intervention allows for definitive treatment with excellent cosmetic and functional outcomes. This case added to the limited literature and reinforced the importance of complete excision to prevent recurrence.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 9","pages":"e7108"},"PeriodicalIF":1.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150408","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}
Karen Li, Rachel N Rohrich, Christian X Lava, Sara Marshall, Wynne Zheng, Rebecca Falconer, Kelly Kapp, Lucy De La Cruz, Ian Greenwalt, Kenneth L Fan
{"title":"\"Going Flat\": Aesthetic Flat Closure as a Breast Reconstruction Option in Gender-nonconforming Patients.","authors":"Karen Li, Rachel N Rohrich, Christian X Lava, Sara Marshall, Wynne Zheng, Rebecca Falconer, Kelly Kapp, Lucy De La Cruz, Ian Greenwalt, Kenneth L Fan","doi":"10.1097/GOX.0000000000007106","DOIUrl":"10.1097/GOX.0000000000007106","url":null,"abstract":"<p><p>Patients who desire a flatter chest contour after mastectomy can opt for aesthetic flat closure (AFC) instead of traditional autologous and breast implant options that recreate the breast mound. AFC is an evolving area of reconstructive surgery in breast reconstruction, and there have been no nipple-sparing techniques demonstrated in the current literature to date. We thus present an AFC surgical technique by the senior author for the oncoplastic gender-nonconforming patient population. Technically, this approach uses an inferior adipodermal flap to preserve the nipple-areola complex, similar to an inferior pedicle-based reduction mammaplasty, while achieving a masculinized chest contour. Key surgical pearls include preoperative planning to align patient goals with chest wall aesthetics, careful intraoperative assessment to ensure adequate nipple perfusion, and intraoperative flexibility in nipple resizing, reshaping, and repositioning to align with the patient's wishes. The technique also allows for customization of chest contour, enabling the creation of a completely flat chest or a small breast mound based on individual patients' preferences. Patients requiring extensive tissue removal or contraindications for breast-conserving surgery should be excluded due to the risk of inadequate nipple perfusion. This is the first and only nipple-sparing AFC technique in the current literature, addressing a need in reconstructive breast surgery for gender-nonconforming populations.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 9","pages":"e7106"},"PeriodicalIF":1.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138406","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}
Alejandro R Gimenez, Rachel Rohrich, Zachary Borab, Sean Fisher, Steven Fagien, Rod J Rohrich
{"title":"Safety and Complications in Lower Eyelid Blepharoplasty: A Systematic Review.","authors":"Alejandro R Gimenez, Rachel Rohrich, Zachary Borab, Sean Fisher, Steven Fagien, Rod J Rohrich","doi":"10.1097/GOX.0000000000007102","DOIUrl":"10.1097/GOX.0000000000007102","url":null,"abstract":"<p><strong>Background: </strong>Lower blepharoplasty is one of the most commonly performed aesthetic procedures in the United States. Although lower blepharoplasty techniques have evolved significantly, it remains a considerable surgical challenge, associated with many aesthetic and functional complications. This review aimed to elucidate the safety and complication profiles of lower blepharoplasty.</p><p><strong>Methods: </strong>A comprehensive review of the literature was performed using PubMed/MEDLINE, Embase, and Cochrane databases to identify studies that report the complication profiles of lower blepharoplasty techniques.</p><p><strong>Results: </strong>A total of 36 articles meeting inclusion criteria and critically evaluating lower blepharoplasty and its associated complications were analyzed and discussed.</p><p><strong>Conclusions: </strong>This review reports the overall safety and low complication profile associated with lower blepharoplasty. No major complications resulting in ocular and visual disturbances are reported, and the majority of complications resulting in functional and aesthetic concerns can be resolved with conservative management or revisionary surgery. More rigorous studies are needed to more critically assess and compare the various surgical techniques.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 9","pages":"e7102"},"PeriodicalIF":1.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137952","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":"Ear Elevation Technique With Hyaluronic Acid Filler Injection.","authors":"Gyu Sik Jung","doi":"10.1097/GOX.0000000000007099","DOIUrl":"10.1097/GOX.0000000000007099","url":null,"abstract":"","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 9","pages":"e7099"},"PeriodicalIF":1.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138463","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}