Rhinology最新文献

{"title":"Linking form to function: a scoping review of the evolution of paranasal sinuses in mammals.","authors":"L E Ebbert, N Kumar, M K Ebbert, T Pace, P Lanca Gomes, L A Marks, D Lal","doi":"10.4193/Rhin25.419","DOIUrl":"https://doi.org/10.4193/Rhin25.419","url":null,"abstract":"<p><strong>Background: </strong>The evolutionary origin and function of paranasal sinuses remain unclear. We investigated their presence, distribution, and drainage orientation across mammalian orders, to better understand their evolutionary development and roles.</p><p><strong>Methodology: </strong>A scoping review of anatomical, radiological, and descriptive literature was conducted in Ovid MEDLINE database (1946-2024). Data on sinus presence, type, and drainage pathways were extracted from representative species across mammalian orders. Phylogenetic (grouping by evolutionary ancestry) and phenetic (grouping by anatomical similarity) analyses were used to identify evolutionary patterns.</p><p><strong>Results: </strong>Final review included 24 articles. Sinus prevalence in mammalian orders was maxillary (50%), frontal (44%), sphenoid (33%) and ethmoid (20%). Frontal sinuses were more common in behaviorally complex orders (71% vs. 22%). Frontal and maxillary sinuses predominated in terrestrial and arboreal mammals, while aquatic and volant mammals largely lacked sinuses. Phenetic clustering by sinus characteristics often contradicted phylogeny, suggesting parallel evolution driven by environment over ancestry. Despite variation in morphology, drainage pathways remained conserved.</p><p><strong>Conclusions: </strong>Paranasal sinus distribution in mammals appears more ecologically than phylogenetically determined, with convergent evolution likely influencing their presence. Conserved drainage patterns suggest developmental constraints over selective advantages. Further studies incorporating underrepresented mammalian orders and sinus size quantification are needed to refine our understanding of paranasal sinus function and evolution.</p>","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":"64 4","pages":"434-443"},"PeriodicalIF":5.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702236","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":"Mepolizumab improves outcomes in patients with CRSwNP with one or more prior nasal polyp surgeries.","authors":"J K Han, J Mullol, M Wagenmann, L Walrave, L Zhang, A R Sousa, P Howarth, C Hopkins","doi":"10.4193/Rhin25.599","DOIUrl":"10.4193/Rhin25.599","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often undergo multiple nasal surgeries. The Phase III SYNAPSE study (GSK ID:205687; NCT0308579) demonstrated that mepolizumab reduces the need for repeat surgery. We explored whether outcomes differed based on the number of prior surgeries.</p><p><strong>Methodology: </strong>This post hoc analysis of SYNAPSE stratified patients by history of 1 or more than 1 prior surgery. Patients were randomised to receive mepolizumab or placebo every 4 weeks, alongside standard of care, for 52 weeks. Outcomes included change from baseline in endoscopic nasal polyp (NP) score, visual analogue scale (VAS) scores for nasal obstruction, loss of smell and overall symptoms, Sino-Nasal Outcome Test-22 (SNOT-22), and time to repeat surgery and/or oral corticosteroid (OCS) use.</p><p><strong>Results: </strong>189 patients had 1 prior surgery (108 mepolizumab; 81 placebo) and 218 had more than 1 prior surgery (98; 120). In both subgroups, mepolizumab significantly improved mean changes versus placebo in NP, nasal obstruction, loss of smell VAS, overall symptom VAS, and SNOT-22. Significant reductions in risk of repeat surgery and requiring OCS were observed with mepolizumab versus placebo in patients with 1 prior surgery.</p><p><strong>Conclusions: </strong>Mepolizumab improves outcomes in patients with CRSwNP with one or multiple prior surgeries; however, may offer greater benefit when initiated after a single surgery.</p>","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":" ","pages":"463-471"},"PeriodicalIF":5.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043584","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":"When sleep improves but AHI does not: comments on mepolizumab +- FESS in severe CRSwNP.","authors":"W-Z Hong","doi":"10.4193/Rhin26.159","DOIUrl":"10.4193/Rhin26.159","url":null,"abstract":"<p><p>We read with great interest the randomized trial by Homoe et al. evaluating mepolizumab with or without functional endo-scopic sinus surgery (FESS) for severe uncontrolled CRSwNP (1), integrating patient-reported sleep outcomes (ESS, FOSQ-10, SNOT-22 sleep items) with WatchPAT-derived indices of sleep-disordered breathing (AHI/ODI). The study addresses a clinically frequent scenario in which patients report prominent fatigue and \"poor sleep\", while OSA may coexist and require indepen-dent management.</p>","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":" ","pages":"575-576"},"PeriodicalIF":5.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147982958","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":"Expanding the olfactory implant paradigm through recent advances in brain-computer interface technology.","authors":"E K Bhargava, M Arvaneh","doi":"10.4193/Rhin25.554","DOIUrl":"10.4193/Rhin25.554","url":null,"abstract":"<p><p>The international opinion paper by Whitcroft et al. provides invaluable guidance for the emerging field of olfactory implants. While the authors thoroughly address clinical considerations and current technological approaches, we would like to expand upon Statements 9.1 and 9.3 regarding electrode technology limitations and highlight recent advances in brain-computer interface (BCI) technology that could address key technological challenges around electrode longevity and biocompatibility.</p>","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":" ","pages":"564-565"},"PeriodicalIF":5.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145998798","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":"Exhaled breath condensate metabolomics reveals conserved networks and bidirectional crosstalk in asthma and CRSwNP.","authors":"Y Yang, W Zhang, L Cui, H Yu, Y Chen, D Wang, J Wang, Y Zhang, X Song","doi":"10.4193/Rhin25.428","DOIUrl":"10.4193/Rhin25.428","url":null,"abstract":"<p><strong>Background: </strong>Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma frequently coexist. However, the metabolic inter-play between those diseases is poorly understood. We aimed to perform metabolomic profiling of exhaled breath condensate (EBC) from CRSwNP and asthma patients and investigate possible interaction pathways.</p><p><strong>Methodology: </strong>EBC samples from the upper and lower airways of patients with CRSwNP, asthma, and control subjects were analyzed using untargeted metabolomics. Metabolite consistency and conserved modules between the upper and lower airways were quantified. WGCNA, trend cluste-ring analysis, and a pathway enrichment analysis of differential metabolite expression were performed.</p><p><strong>Results: </strong>A total of 252 metabolites were identified, with a strong correlation between the upper and lower airway profiles. WGCNA analysis showed that each module of the upper or lower airway was conserved, with at least 1 module included in the consensus network. The key enriched pathways for lower airway metabolites showed a continuous increasing or decreasing trend in the control, CRSwNP, and asthma groups, and mainly involved the impact of CRSwNP on asthma. The main enriched pathways for upper airway differential metabolites in the control, asthma, and CRSwNP groups were related to the impact of asthma on nasal polyps. N-(8Z,11Z,14Z-eicosatrienoyl) ethanolamine was significantly down-regulated in the EBC of CRSwNP and asthma patients, and was negatively correlated with the risk for CRSwNP and asthma onset. Leukotriene F4 (LTF4) was up-regulated in the EBC of CRSwNP and asthma patients, and was positively correlated with the risk for CRSwNP onset.</p><p><strong>Conclusion: </strong>Non-invasive EBC metabolomics revealed conserved metabolic networks and bidirectional perturbations between CRSwNP and asthma, providing new evidence for the &quot;unified airway&quot; hypothesis.</p>","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":" ","pages":"482-493"},"PeriodicalIF":5.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646295","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":"Relationship between olfactory function and quality of life in COVID-19 patients.","authors":"S Winkelmann, M A Nasr, A Korth, B Voss, N Behrend, P Pudszuhn, C Maetzler, A Hermes, K Franzpoetter, A-K Ruß, D Pape, S Stork, F A Montellano, M Witzenrath, T Keil, M Krawczak, W Lieb, S Schreiber, T Bahmer, M Laudien, Napkon Study Group","doi":"10.4193/Rhin24.174","DOIUrl":"10.4193/Rhin24.174","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 is associated with multiple long-term impairments that negatively affect patients' quality of life (QoL). Of these, olfactory dysfunction (OD), which is difficult to measure in practice, is likely to play an important role as it highly affects peoples’ QoL.</p><p><strong>Methods: </strong>In a population-based study, a total of 667 adult participants (mean age: 47 years) were examined nine months, on average, after positive PCR testing for SARS-CoV-2. Subjective olfactory function (OF) was quantified by means of a Visual Analogue Scales (OF-VAS). OF was tested by way of the Sniffin’ Sticks Test (SST). The self-reported Mini Olfactory Questionnaire (self-MOQ) was used to screen for OD. The brief (short) version of the Questionnaire of Olfactory Disorders - Negative Statements (sQOD-NS), the sinonasal outcome Test-22 (SNOT-22), the EuroQoL 5-Dimension 5-Level (EQ-5D-5L), and the EuroQoL-VAS (EQVAS) were used to assess QoL.</p><p><strong>Results: </strong>Participants with SST-tested OD or with OF-VAS-based subjective OD were characterized by significantly higher self-MOQ scores. Diagnoses of OD by self-MOQ or SST were found to be strongly correlated. Moreover, both the TDI score and the OF-VAS score were negatively correlated with the self-MOQ score. In addition to a significant reduction of QoL in participants with tested OD, the four questionnaires used in the present study also consistently highlighted a significant negative correlation between QoL and both, self-MOQ and OF-VAS score.</p><p><strong>Conclusion: </strong>The self-MOQ is a sufficient screening tool for OD after SARS-CoV-2 infection. Patients with persistent OD show signi-ficantly poorer QoL than those without.</p><p><strong>Clinical implications: </strong>Olfactory function can be assessed in patients with COVID-19 using a simple 5-item questionnaire (self-MOQ). Patients with OD show reduced QoL.</p><p><strong>Capsule summary: </strong>In our population-based cross-sectional study of 667 patients with PCR-confirmed SARS-CoV-2 infection, par-ticipants with persistent OD had significantly poorer OF-related QoL. The self-MOQ is a simple, valid and reliable means to screen OD in patients with COVID-19.</p>","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":" ","pages":"502-511"},"PeriodicalIF":5.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699594","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":"Economic analysis of surgery and biological therapy for chronic rhinosinusitis with nasal polyps.","authors":"J Maza-Solano, L Garcia Mochon, J Martin-Martin, P W Hellings, S Sanchez-Gomez","doi":"10.4193/Rhin25.529","DOIUrl":"10.4193/Rhin25.529","url":null,"abstract":"<p><strong>Background: </strong>Chronic rhinosinusitis with nasal polyps (CRSwNP) imposes major health and economic burdens. Endoscopic sinus surgery (ESS) and biologic therapy are treatment options. This study compares their effectiveness and cost-efficiency from the Spanish National Health System (NHS) perspective.</p><p><strong>Methodology: </strong>An economic evaluation was conducted in severe CRSwNP, following Spanish-NHS guidelines. Data came from a tertiary-hospital with 10-year projections. Effectiveness was measured as reduction in the Sinonasal Outcome Test-22 (SNOT-22). Cost-utility analysis used quality-adjusted life years (QALYs). Micro-costing was applied for ESS, while annual drug costs were considered for biologics. Sensitivity analyses tested robustness.</p><p><strong>Results: </strong>89 patients were included (63 ESS, 26 biologics). After 2-years, both strategies achieved similar SNOT-22 improvements (-31.8 ESS, -31.0 biologics). Costs were far lower for ESS (EUR 5,302.78) than biologics (EUR 27,198.23), making biologics less efficient despite comparable benefit. The 2-year incremental cost-utility ratio (ICUR) for biologics was EUR 1.2 million/QALY, above accepted thresholds. At 10-years, biologics yielded 2.75 QALYs at an incremental cost of EUR 108,917.62 (ICUR EUR 39,592/QALY). Sensitivity ana-lyses showed that biologics generally remained above commonly accepted willingness-to-pay thresholds, although substantial price reductions (up to 40%) allowed ICURs to approach the upper limit of acceptability.</p><p><strong>Conclusions: </strong>Both treatments provide meaningful improvement. ESS remained the less costly strategy and was more efficient over the short term, whereas long-term projections showed higher QALY gains with biologics at substantially greater cost. Within Spanish- NHS, biologics may approach cost-effectiveness only under favorable pricing assumptions and should be reserved for patients with contraindications or persistent disease after ESS.</p>","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":" ","pages":"472-481"},"PeriodicalIF":5.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147983021","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":"Combining EBV DNA dynamics with RECIST-based radiographic response to improve prognostic stratification of recurrent/metastatic nasopharyngeal carcinoma in the era of immunotherapy.","authors":"H X Long, S C Li, C R Lai, C L Huang, X S Sun, B W Shen, J Y Shen, H J Wang, Y F Li, J Chen, H Cheng, L T Liu, Q Y Chen, H Q Chen, L Q Tang","doi":"10.4193/Rhin25.511","DOIUrl":"10.4193/Rhin25.511","url":null,"abstract":"<p><strong>Background: </strong>This study assessed the prognostic value of early Epsteinâ€\"Barr virus (EBV) DNA dynamics combined with Response Evaluation Criteria in Solid Tumours (RECIST)-based radiographic response in patients with recurrent/metastatic nasopharyngeal carcinoma (R/M NPC) receiving immunotherapy, to refine risk stratification.</p><p><strong>Methodology: </strong>A real-world cohort of 306 patients with R/M NPC and detectable EBV DNA at baseline received PD-1 monoclonal antibodies (PD-1 mAbs), alone or with chemotherapy. EBV DNA and radiological assessments were performed at baseline and after two therapy cycles. Biological responses based on EBV DNA were compared with RECIST evaluations. Survival outcomes were analysed using inverse probability treatment weighting, and a Cox regression model was developed incorporating baseline features and early responses.</p><p><strong>Results: </strong>Among 306 patients, 174 achieved complete biological response (cBR), and 203 achieved complete or partial radiological response (CR/PR). Patients achieving both cBR and CR/PR had the most favourable progression-free survival. Early cBR was the dominant prognostic factor for overall survival, whereas radiological response did not affect overall survival within biological response strata. A prediction model integrating baseline features, radiological, and biological responses achieved an optimismcorrected C-index, surpassing models with baseline features alone, baseline plus radiological response, and baseline with biological response.</p><p><strong>Conclusions: </strong>Early biological response by EBV DNA was a stronger prognosticator than radiological response in PD-1 mAbs-treated R/M NPC. Combining baseline clinical features with biological and radiological responses improved survival prediction.</p>","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":" ","pages":"553-563"},"PeriodicalIF":5.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043591","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":"Biologics for chronic rhinosinusitis with nasal polyps: a real-world prospective cohort study.","authors":"M Blauwblomme, A-S Viskens, E Bonne, E Borgers, C Cox, G De Vos, L Derycke, A-S Eeckels, S Halewyck, V Hox, P Janssen, P Janssen, W Lemmens, F Rogister, K Speleman, M Syssauw, O Vanderveken, E Vandewalle, S Vanhee, B Verhaeghe, A V Vroegop, T Van Zele, P Gevaert, P W Hellings","doi":"10.4193/Rhin26.004","DOIUrl":"10.4193/Rhin26.004","url":null,"abstract":"<p><strong>Background: </strong>Monoclonal antibody therapies targeting type 2 inflammation for chronic rhinosinusitis with nasal polyps (CRSwNP) have shown efficacy in randomized controlled trials (RCTs), however prospective real-world comparative data across all appro-ved biologics remain limited. We aimed to evaluate the real-world effectiveness of omalizumab, mepolizumab, and dupilumab in patients with severe CRSwNP.</p><p><strong>Methodology: </strong>A prospective, multicentre, real-world phase IV study in Belgium, enrolling 360 patients with severe CRSwNP initiating treatment with omalizumab (n=65), mepolizumab (n=242), or dupilumab (n=53) between March 2022 and April 2025. Clinical data were collected at baseline and after 6 months. The therapeutic response was evaluated based on EUFOREA criteria.</p><p><strong>Results: </strong>After 6 months, nasal polyp score (NPS), olfactory function, and patient-reported outcomes improved across all biologics, with concurrent improvements in asthma control within each treatment group. A good-to-excellent multidomain therapeutic response was achieved in 51% of patients, and treatment continuation beyond 6 months was observed in 74% of omalizumab-, 81% of mepolizumab-, and 92% of dupilumab-treated patients. No severe adverse events were reported.</p><p><strong>Conclusion: </strong>In this real-world cohort, the three registered biologics provided significant clinical benefit in severe CRSwNP, with numerically larger improvements observed in patients treated with dupilumab.</p>","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":" ","pages":"453-462"},"PeriodicalIF":5.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691962","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":"Long-term dupilumab therapy reduces concomitant medication use in patients with CRSwNP.","authors":"K Berbalk, N J Campion, T J Bartosik, L Liu, M Pan, C Morgenstern, V Stanek, A Tu, S Stoshikj, J Eckl-Dorna, S Schneider","doi":"10.4193/Rhin25.523","DOIUrl":"10.4193/Rhin25.523","url":null,"abstract":"<p><strong>Background: </strong>Dupilumab has demonstrated efficacy in Chronic Rhinosinusitis with Nasal Polyps. While its impact on sinonasal and asthma symptoms is well established, less is known about its effects on the demand for concomitant medications in long-term routine care.</p><p><strong>Methodology: </strong>This retrospective longitudinal real-world study included 224 patients diagnosed with Chronic Rhinosinusitis with Nasal Polyps and treated with Dupilumab at a tertiary centre between 2019 and 2025, with a maximum follow-up of up to 4.5 years. At each visit, use of nasal sprays, asthma drugs, and other disease-related drugs was recorded. Linear mixed-effects models were fitted to assess longitudinal changes.</p><p><strong>Results: </strong>At baseline, patients reported a mean of 1.6 concomitant medications, most commonly INCS and inhaled asthma drugs. The total number of concomitant medications, the number of nasal sprays, asthma medications, and other disease-related drugs decreased significantly over time. Parallel improvements were observed in patient-reported outcome measures (SNOT-22, TNSS, ACT, miniAQLQ).</p><p><strong>Conclusions: </strong>In this real-world cohort, Dupilumab treatment led to a sustained overall reduction in concomitant medication use, thereby lowering pharmacological burden while improving disease control.</p>","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":" ","pages":"444-452"},"PeriodicalIF":5.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481751","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}