Spinal cord最新文献

{"title":"Providing a QuickStart for people with newly acquired spinal cord injury: a new model of care offering in-reach advice and support.","authors":"Susan M Stoikov, Chau T D Do, Kiley J Pershouse, Claire E Panagoda, Donna G Harre, Delena I Amsters","doi":"10.1038/s41393-025-01086-w","DOIUrl":"10.1038/s41393-025-01086-w","url":null,"abstract":"<p><strong>Study design: </strong>Descriptive study of a pilot model of care named QuickStart.</p><p><strong>Objectives: </strong>To describe the eligibility, rehabilitation pathways, team composition, and service delivery of a novel model of care for people with newly acquired spinal cord injuries (SCI).</p><p><strong>Setting: </strong>Queensland Spinal Cord Injuries Service, Metro South Health, Queensland, Australia.</p><p><strong>Methods: </strong>In April 2022, QuickStart was established with a multidisciplinary team of health professionals to provide early in-reach specialist SCI expertise to individuals with newly acquired spinal cord injury and their treating clinicians.</p><p><strong>Results: </strong>Between July 2022 and June 2024, QuickStart accepted 508 patients who were admitted to a Queensland or northern New South Wales hospital. Patients who received QuickStart support followed one of two pathways: they completed their primary rehabilitation in the Spinal Injuries Unit (SIU) at Princess Alexandra Hospital or at another facility. QuickStart provides specialised SCI support to patients and their treating team via a range of modalities including face-to-face review, telephone and videoconference. Referral numbers increased by 22% from the first year of operation, along with a 38% increase in the average QuickStart caseload. Patients received, on average, 12 occasions of service and a total service provision time of 452 min. All QuickStart patients received referrals to other specialised SCI community services within the Queensland Spinal Cord Injuries Service.</p><p><strong>Conclusion: </strong>QuickStart is a promising model of care that has improved access to specialised SCI expertise for individuals with newly acquired SCI, particularly those who may not have immediate access to specialised rehabilitation services.</p>","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":" ","pages":"285-291"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982727","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":"A message from Spinal Cord's Editor-in-Chief.","authors":"Michael G Fehlings","doi":"10.1038/s41393-025-01093-x","DOIUrl":"10.1038/s41393-025-01093-x","url":null,"abstract":"","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":" ","pages":"277-278"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216989","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":"Priorities for support service needs among individuals with spinal cord injury.","authors":"Hye Jin Nam, Haesun Lee, Ju Young Yoon","doi":"10.1038/s41393-025-01079-9","DOIUrl":"10.1038/s41393-025-01079-9","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional survey.</p><p><strong>Objectives: </strong>This study aims to identify and prioritize the gaps between the required and current levels of support services for individuals with SCI in South Korea.</p><p><strong>Setting: </strong>Community.</p><p><strong>Methods: </strong>The cross-sectional analysis involved 532 participants who are members of the Korea Spinal Cord Injury Association. These participants were recruited through the 2021 Survey on Needs of People with SCI, conducted via face-to-face interviews by trained investigators. The survey assesses the demand and current levels of 11 key support services. The Borich needs assessment and the locus for focus model were employed to identify the priorities of these services.</p><p><strong>Results: </strong>Results indicated significant disparities between the required and current levels across all services. Among the 532 participants, 70.1% were male and the average age was 49.6 years. The highest priority services were identified as \"support for caregiver costs,\" \"livelihood security,\" \"health management,\" and \"home modification\". Secondary priorities included \"training for daily living activities\" and \"vocational rehabilitation.\"</p><p><strong>Conclusions: </strong>The study emphasizes the importance of aligning service provision with the specific needs of the SCI population to enhance their quality of life and promote successful reintegration into the community. The findings underscore the urgent need for comprehensive support systems to address the economic and functional challenges of individuals with SCI. Policymakers and service providers are encouraged to focus on these identified priorities to better meet the needs of individuals with SCI, to ensure their sustained independence and improved well-being.</p>","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":" ","pages":"298-305"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12173941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of pressure injuries with associated osteomyelitis in people with spinal cord injury: a national survey of referral centers in France.","authors":"Hélène Le Liepvre, Emma D'Anglejan, Haude Chaussard, Damien Marmouset, Killian Allepot, Frédérique Bouchand, Latifa Noussair, François Genêt, Vincent T Carpentier, Aurélien Dinh","doi":"10.1038/s41393-025-01084-y","DOIUrl":"10.1038/s41393-025-01084-y","url":null,"abstract":"<p><p>Pressure injuries are common among individuals with spinal cord injury and often complicated by superinfection, leading to sepsis, hospitalizations, and significant healthcare costs. Osteomyelitis associated with pressure injuries poses diagnostic challenges and requires effective medical and surgical management. To investigate current practices, a national survey of French centers managing over 20 cases annually was conducted. Results revealed significant variability in surgical techniques, antibiotic protocols, and people care pathways. Musculocutaneous and perforator flaps were commonly used, but their application differed among centers. No flaps were performed during acute infections due to failure risks. Bedridden periods and hip flexion protocols varied, with prolonged immobility linked to complications such as thromboembolism and malnutrition. Antibiotic durations ranged from 5-180 days, reflecting differing approaches to infection management. Cure rates within one year ranged from 70-90%. These findings underscore the need for standardized, evidence-based protocols to optimize care for this vulnerable population.</p>","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":" ","pages":"319-322"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12173937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using diffusion tensor imaging to assess children with spinal cord injury without fracture or dislocation.","authors":"Qunya Qi, Ling Wang, Beining Yang, Yulong Jia, Yu Wang, Haotian Xin, Xianglin Guo, Weimin Zheng, Xin Chen, Qian Chen, Fang Li, Jubao Du, Jie Lu, Nan Chen","doi":"10.1038/s41393-025-01091-z","DOIUrl":"https://doi.org/10.1038/s41393-025-01091-z","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Objectives: </strong>This study investigates changes in spinal DTI metrics above lesion in children with spinal cord injury without fracture or dislocation (SCIWOFD), aiming to assess DTI's potential as a diagnostic and evaluative tool for SCIWOFD in children.</p><p><strong>Setting: </strong>Xuanwu Hospital, Capital Medical University, China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, China.</p><p><strong>Methods: </strong>This study included 18 children with SCIWOFD and 12 typically developing (TD) children. SCIWOFD children underwent International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) assessments and MRI with axial spinal cord DTI. DTI data were processed with Diffusion Toolkit and TrackVis, with four levels above the lesion (Level 1 to Level 4). Spinal DTI metrics were extracted, and statistical analysis was performed using multiple linear regression and Pearson correlation.</p><p><strong>Results: </strong>Compared to the TD group, the SCIWOFD group displayed significant changes in DTI metrics at four spinal cord levels. At level 1, FA decreased (p < 0.000), while MD (p < 0.000), AD (p = 0.007), and RD (p < 0.000) increased. Levels 2 and 3 showed decreased FA (level 2: p < 0.000; level 3: p = 0.001) and increased MD (level 2: p = 0.001; level 3: p = 0.029) and RD values (level 2: p < 0.000; level 3:p = 0.001). At level 4, FA decreased (p < 0.000), while RD increased (p = 0.009). At level 1 in the SCIWOFD group, MD (r = -0.534, p = 0.022) and RD (r = -0.569, p = 0.009) correlated with sensory scores.</p><p><strong>Conclusions: </strong>Spinal DTI metrics above the lesion in children with SCIWOFD exhibit gradient changes, with a statistically correlation between the DTI metrics at the rostral edge of the lesion and ISNCSCI sensory scores. DTI metrics may serve as stable, objective indicators for assessing SCIWOFD in children.</p>","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192229","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":"Translation and validation of the French version of the spinal cord independence measure III (SCIM III).","authors":"Clara Dupriez, Antoine Royer, Emiko Naets, Violaine Afzali, Kambiz Minooee Saberi","doi":"10.1038/s41393-025-01082-0","DOIUrl":"https://doi.org/10.1038/s41393-025-01082-0","url":null,"abstract":"<p><strong>Study design: </strong>This is a monocenter, prospective validation study.</p><p><strong>Objectives: </strong>To assess the validity and reliability of the French version of the Spinal Cord Independence Measure III (SCIM III).</p><p><strong>Setting: </strong>This study was conducted in Center for Traumatology and Rehabilitation, Brussels (Belgium).</p><p><strong>Methods: </strong>We included eighteen (n = 18) participants with spinal cord injury (SCI), scored according to the International Standards for Neurological Classification of SCI (ISNCSCI). Backward and forward translation of SCIM III was performed. Each participant was scored for the translated SCIM III and Functional Independence Measure (FIM) by three physicians. We evaluate the internal consistency, the intra- and inter-reliability, the validity and the sensitivity to change with Cronbach's alpha coefficient, Kappa coefficient, intraclass correlation coefficients (ICC), Pearson's correlation, paired t-test and McNemar test. For the validity, we compared SCIM III scores with those of the FIM.</p><p><strong>Results: </strong>The French SCIM III (frSCIM III) provided excellent internal consistency. Kappa values for inter-reliability were all above 0.60, except for 3 items, and were statistically significant. We found a strong correlation between raters. All the tests showed a very good intra-reliability. frSCIM III and FIM showed very good correlation. There was no significant difference in the sensitivity to change between the frSCIM III and the FIM.</p><p><strong>Conclusion: </strong>The frSCIM III proved to be a consistent, reliable, and valid scale for clinical use. It is the first functional assessment scale validated in French for people with SCI.</p><p><strong>Sponsorship: </strong>None.</p>","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182928","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":"Mapping sex and gender in the landscape of spinal cord injury research: a bibliometric analysis and research framework.","authors":"Stevan Stojic, Serena Affolter, Gertraud Stadler, Stacey A Missmer, Juergen Pannek, Jivko Stoyanov, Inge Eriks-Hoogland, Janina Lüscher, Marija Glisic","doi":"10.1038/s41393-025-01089-7","DOIUrl":"https://doi.org/10.1038/s41393-025-01089-7","url":null,"abstract":"<p><strong>Study design: </strong>Bibliometric analysis and conceptual framework.</p><p><strong>Objectives: </strong>To provide a framework for prioritizing sex/gender research in the field of spinal cord injury (SCI), which can help inform and develop future research directions benefiting both women and men affected by SCI.</p><p><strong>Setting: </strong>Not applicable METHODS: We searched the Web of Science Core Collection to identify relevant articles. Data was analyzed using the Bibliometrix and VoSviewer tools to provide a macroscopic overview of sex/gender research trends in the field of SCI research. A framework was developed based on the results of bibliometric analyses and literature scoping, engaging professionals with backgrounds in gender medicine, translational medicine, psychology, clinical epidemiology, SCI, and endocrinology.</p><p><strong>Results: </strong>A total of 1031 documents were included in the analyses. We observed a steady increase in sex/gender related research from 2012, with an annual growth rate of 9.64%. Rehabilitation, epidemiology, obesity, depression, and sex hormones were identified as fundamental and critical topics for advancing sex and gender research in the context of SCI. Among a randomly selected articles, a significant proportion of studies interchangeably used the terms sex and gender. Therefore, we discuss the key overarching themes and terminology that are essential for any study exploring the relevance of sex and gender in health research. We developed a three-step research framework for considering and incorporating sex and gender in research, using SCI as a case in point.</p><p><strong>Conclusion: </strong>The major principles in current paper can benefit everyone interested in studying sex/gender in the context of health in complex and disabling conditions.</p>","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182826","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":"Evaluating therapeutic effects of exoskeletons and FES in SCI: integrative review of the literature.","authors":"Rachel Y Kim, Olivia M Biller, M J Mulcahey","doi":"10.1038/s41393-025-01085-x","DOIUrl":"https://doi.org/10.1038/s41393-025-01085-x","url":null,"abstract":"<p><strong>Background: </strong>Functional electrical stimulation and exoskeletons provide direct functional ability but may also have therapeutic effects that improve function when they are turned off or removed.</p><p><strong>Objective: </strong>This integrative review aimed to identify functional clinical outcome assessments used to assess therapeutic effects in rehabilitation technologies for persons with spinal cord injuries, to examine the National Institute of Neurological Disorders and Stroke Common Data Elements recommendation level for SCI for each COA, and determine which COAs distinguish between recovery of function and function from compensation.</p><p><strong>Methods: </strong>A literature search identified interventional SCI studies using FES and exoskeletons (n = 1006). Text screens resulted in a sample (n = 56) organized by level of evidence, COAs with their measurement properties, type of intervention with involved limbs, the NINDS CDE recommendation level, and if the COAs distinguished recovery from compensation.</p><p><strong>Results: </strong>56 articles met inclusion criteria. 31 studies involved exoskeletons, 23 studies involved FES, and 2 studies involved both FES and exoskeleton. Within those 56 articles, 38 COAs were identified across all studies, including different versions of the same COA as separate measures. Of these 38 COAs, 24 were PerfOs and 7 were PROs. The most used COAs did not differentiate recovery from compensation. However, 3 COAs were identified as able to discriminate recovery from compensation.</p><p><strong>Conclusions: </strong>Studies on FES and exoskeletons in SCI have precedent to examine therapeutic effects using a variety of functional COAs. Clinical trials in SCI would benefit from COAs with interval scales that assess therapeutic effects that differentiate between recovery and compensation.</p>","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181895","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":"How many cases of spinal intramedullary ependymoma surgery are required to achieve stability? - Analysis using X-bar charts.","authors":"Narihito Nagoshi, Kengo Nagashima, Toshiki Okubo, Masahiro Ozaki, Satoshi Suzuki, Kazuki Takeda, Takahito Iga, Morio Matsumoto, Masaya Nakamura, Kota Watanabe","doi":"10.1038/s41393-025-01090-0","DOIUrl":"https://doi.org/10.1038/s41393-025-01090-0","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>To evaluate surgical consistency and clinical outcomes in intramedullary ependymoma (WHO grade II) cases by using X-bar charts as a tool to assess procedural stability.</p><p><strong>Setting: </strong>The single institution in Japan.</p><p><strong>Methods: </strong>This study included patients who underwent resection of intramedullary ependymomas between 2001 and 2023. All surgeries were performed by one of five board-certified spine surgeons. Operative time was analyzed for stability using X-bar charts. Neurological outcomes were assessed using the modified McCormick Scale (mMS), and regression analysis was performed to evaluate the relationship between operative time and mMS.</p><p><strong>Results: </strong>The study included 144 patients (82 men, 62 women; average age 50.3 ± 14.6 years). Tumors were located at cervical (67.4%) or thoracic (32.6%) levels, averaging 3.0 ± 1.2 vertebrae. The surgeon who performed 71 cases was defined as the experienced surgeon, and the other surgeons performed 10-24 cases, respectively. The mean operative time was 380.6 ± 140.7 min, and 135 cases achieved gross total resection. The average follow-up duration was 6.9 ± 3.9 years. X-bar charts showed surgical stability once the average number of cases exceeded 17. No significant correlation was found between operative time and mMS for any surgeon. Perioperative complications were minimal.</p><p><strong>Conclusions: </strong>X-bar charts are a valuable tool for objectively evaluating surgical stability. In intramedullary ependymoma surgeries, consistency in operative time was achieved after 17 cases, and longer procedures did not adversely affect neurological outcomes. This method could be extended to monitor procedural reliability in other complex surgical interventions.</p>","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120867","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":"BDNF-GABA signaling in astrocytes: enhancing neural repair after SCI through MSC therapies.","authors":"Qingsheng Zhou, Qiongxuan Fang, Chunming Zhang, Wei Liu, Yifeng Sun","doi":"10.1038/s41393-025-01077-x","DOIUrl":"https://doi.org/10.1038/s41393-025-01077-x","url":null,"abstract":"<p><strong>Study design: </strong>An integrated bioinformatics data study.</p><p><strong>Objective: </strong>This study, through bioinformatics analysis, aims to map the landscape of astrocytes, explore key signaling pathways, and uncover molecular mechanisms that support SCI recovery facilitated by MSCs and iPSCs.</p><p><strong>Setting: </strong>Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University.</p><p><strong>Methods: </strong>We performed a bioinformatics analysis of single-cell transcriptomes (scRNA-seq), spatial transcriptomics, and bulk RNA-seq data sourced from Gene Expression Omnibus (GEO) datasets. The data processing involved R packages like \"Seurat,\" \"DESeq2,\" and \"WGCNA.\" For pathway enrichment, we used Gene Set Enrichment Analysis (GSEA) and the Enrichr web server.</p><p><strong>Results: </strong>Single-cell and spatial transcriptomic analysis revealed notable changes in the astrocyte landscape after SCI, highlighting a significant disruption in astrocyte populations within the injured region. Findings suggest that BDNF regulation of GABA neurotransmission and GABA receptor signaling in astrocytes plays a key role in promoting neuronal regeneration. Additionally, hUC-MSCs were found to enhance neural repair by activating BDNF-regulated GABA signaling of astrocytes. A promising alternative involves iPS-derived MSCs, which have shown potential to boost neural regeneration through BDNF, GABA, and GABA receptor signaling pathways of astrocytes.</p><p><strong>Conclusions: </strong>In summary, SCI disrupts astrocyte populations, impacting their ability to support neural repair. BDNF-regulated GABA signaling in astrocytes is essential for neuron regeneration. Both hUC-MSCs and iPS-derived MSCs show promise in enhancing neural recovery by activating these pathways, offering potential new therapeutic options for SCI.</p>","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 5","pages":"263-269"},"PeriodicalIF":2.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062225","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}