Ultrasound in Obstetrics & Gynecology最新文献

{"title":"Reply.","authors":"K Mikolaj, C A Taksøe-Vester, O B B Petersen, N G Vejlstrup, A N Christensen, A Feragen, M Nielsen, M B S Svendsen, M G Tolsgaard","doi":"10.1002/uog.29160","DOIUrl":"10.1002/uog.29160","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"392-393"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoughts on the contribution of artificial intelligence (AI) to assessment of the fetal heart: a true scientific odyssey.","authors":"E Quarello, E Corno","doi":"10.1002/uog.29185","DOIUrl":"10.1002/uog.29185","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"292-294"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of maternal body mass index with hemodynamic and vascular alterations at 35-37 weeks' gestation.","authors":"M Charakida, C Chatzakis, L A Magee, A Syngelaki, T Mansukhani, P von Dadelszen, K H Nicolaides","doi":"10.1002/uog.29170","DOIUrl":"10.1002/uog.29170","url":null,"abstract":"<p><strong>Objective: </strong>Globally, one in four pregnant women is classified as overweight or obese, based on their prepregnancy body mass index (BMI). Obese pregnant women are at increased risk of adverse pregnancy outcomes and long-term cardiovascular disease that occurs earlier in life. This study aimed to assess maternal hemodynamic and vascular parameters at 35-37 weeks' gestation, to understand the alterations that may occur in association with increased maternal BMI and gestational weight gain, and to evaluate obesity-related pregnancy outcomes.</p><p><strong>Methods: </strong>This was a prospective observational study of 11 731 women with a singleton pregnancy attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation at King's College Hospital, London, UK, between December 2021 and June 2024. Women were categorized based on their BMI at 11-13 weeks' gestation, as normal weight (BMI, 18.5-24.9 kg/m<sup>2</sup>), overweight (BMI, 25.0-29.9 kg/m<sup>2</sup>) or obese (BMI, ≥ 30 kg/m<sup>2</sup>). We recorded details regarding maternal demographic characteristics and medical history, used Doppler ultrasound to assess the uterine artery pulsatility index (UtA-PI) (as a marker for uteroplacental perfusion) and ophthalmic artery peak systolic velocity (PSV) ratio (as a marker for small vessel peripheral circulation), and measured carotid-to-femoral pulse-wave velocity, augmentation index (as direct and indirect markers of aortic stiffness, respectively), cardiac output, total peripheral resistance (TPR), and central systolic and diastolic blood pressure. Multivariable analysis was performed to examine the relationship of BMI and gestational weight gain with hemodynamic and vascular measures, adjusting for maternal demographics, medical history, pregnancy characteristics and pregnancy outcomes (including pre-eclampsia and gestational diabetes mellitus).</p><p><strong>Results: </strong>Overweight and obese women were more often of black ethnicity, and had higher central systolic and diastolic blood pressure, cardiac output, aortic stiffness and UtA-PI, compared with normal-weight women. There was no significant difference between overweight or obese women and normal-weight women with regard to TPR and ophthalmic artery PSV ratio. On multivariable analysis, increasing BMI at 11-13 weeks and gestational weight gain between 11-13 weeks and 35-37 weeks were independently associated with increases in all cardiovascular indices (including ophthalmic artery PSV ratio), apart from TPR.</p><p><strong>Conclusions: </strong>Women with a high BMI in early pregnancy vs normal-weight women, and those with higher gestational weight gain, had worse maternal hemodynamic and vascular indices at 35-37 weeks' gestation, independent of baseline and pregnancy characteristics. Our findings support the notion that optimization of prepregnancy weight and gestational weight gain may improve maternal hemodynamics and vascular function during pregnancy","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"303-310"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Could maternal rest improve adverse outcome in fetuses defined by abnormal growth trajectory?","authors":"G R DeVore","doi":"10.1002/uog.29152","DOIUrl":"10.1002/uog.29152","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"393-394"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra- and interobserver agreement of proposed objective transvaginal ultrasound image-quality scoring system for use in artificial intelligence algorithm development.","authors":"A Deslandes, J C Avery, H-T Chen, M Leonardi, S Knox, G Lo, R O'Hara, G Condous, M L Hull","doi":"10.1002/uog.29178","DOIUrl":"10.1002/uog.29178","url":null,"abstract":"<p><strong>Objectives: </strong>The development of valuable artificial intelligence (AI) tools to assist with ultrasound diagnosis depends on algorithms developed using high-quality data. This study aimed to test the intra- and interobserver agreement of a proposed image-quality scoring system to quantify the quality of gynecological transvaginal ultrasound (TVS) images, which could be used in clinical practice and AI tool development.</p><p><strong>Methods: </strong>A proposed scoring system to quantify TVS image quality was created following a review of the literature. This system involved a score of 1-4 (2 = poor, 3 = suboptimal and 4 = optimal image quality) assigned by a rater for individual ultrasound images. If the image was deemed inaccurate, it was assigned a score of 1, corresponding to 'reject'. Six professionals, including two radiologists, two sonographers and two sonologists, reviewed 150 images (50 images of the uterus and 100 images of the ovaries) obtained from 50 women, assigning each image a score of 1-4. The review of all images was repeated a second time by each rater after a period of at least 1 week. Mean scores were calculated for each rater. Overall interobserver agreement was assessed using intraclass correlation coefficient (ICC), and interobserver agreement between paired professionals and intraobserver agreement for all professionals were assessed using weighted Cohen's kappa and ICC.</p><p><strong>Results: </strong>Poor levels of interobserver agreement were obtained between the six raters for all 150 images (ICC, 0.480 (95% CI, 0.363-0.586)), as well as for assessment of the uterine images only (ICC, 0.359 (95% CI, 0.204-0.523)). Moderate agreement was achieved for the ovarian images (ICC, 0.531 (95% CI, 0.417-0.636)). Agreement between the paired sonographers and sonologists was poor for all images (ICC, 0.336 (95% CI, -0.078 to 0.619) and 0.425 (95% CI, 0.014-0.665), respectively), as well as when images were grouped into uterine images (ICC, 0.253 (95% CI, -0.097 to 0.577) and 0.299 (95% CI, -0.094 to 0.606), respectively) and ovarian images (ICC, 0.400 (95% CI, -0.043 to 0.669) and 0.469 (95% CI, 0.088-0.689), respectively). Agreement between the paired radiologists was moderate for all images (ICC, 0.600 (95% CI, 0.487-0.693)) and for their assessment of uterine images (ICC, 0.538 (95% CI, 0.311-0.707)) and ovarian images (ICC, 0.621 (95% CI, 0.483-0.728)). Weak-to-moderate intraobserver agreement was seen for each of the raters with weighted Cohen's kappa ranging from 0.533 to 0.718 for all images and from 0.467 to 0.751 for ovarian images. Similarly, for all raters, the ICC indicated moderate-to-good intraobserver agreement for all images overall (ICC ranged from 0.636 to 0.825) and for ovarian images (ICC ranged from 0.596 to 0.862). Slightly better intraobserver agreement was seen for uterine images, with weighted Cohen's kappa ranging from 0.568 to 0.808 indicating weak-to-strong agreement, and ICC ranging","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"364-371"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of deep or ovarian endometriosis on pelvic pain and quality of life: prospective cross-sectional ultrasound study.","authors":"P Chaggar, T Tellum, N Thanatsis, L V De Braud, T Setty, D Jurkovic","doi":"10.1002/uog.29150","DOIUrl":"10.1002/uog.29150","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether premenopausal women diagnosed with deep or ovarian endometriosis on transvaginal sonography (TVS) were more likely to suffer from dyspareunia and pelvic pain symptoms, and have a lower quality of life, compared to women without sonographically diagnosed deep or ovarian endometriosis.</p><p><strong>Methods: </strong>This was a prospective, cross-sectional study carried out between February 2019 and October 2020 at the general gynecology clinic at University College London Hospital, London, UK. All premenopausal women aged 18-50 years, who were examined consecutively by a single experienced examiner and underwent a detailed TVS scan, were eligible for inclusion. Pregnant women and those who had received a previous diagnosis of endometriosis or who had experienced a hysterectomy or unilateral/bilateral oophorectomy were excluded. Sonographic findings consistent with deep or ovarian endometriosis were noted. All women completed the British Society of Gynaecological Endoscopy pelvic pain questionnaire. The primary outcome was to determine whether women with sonographic evidence of endometriosis were more likely to experience moderate-to-severe levels of dyspareunia (score of ≥ 4 on an 11-point numerical rating scale (NRS)). Secondary outcomes included assessing moderate-to-severe levels of other pelvic pain symptoms (NRS score of ≥ 4), bowel symptoms (score of ≥ 2 on a 5-point Likert scale) and quality of life, which was measured using the EuroQol-5D-3L (EQ-5D) questionnaire. The number of women with pain scores ≥ 4 and bowel scores ≥ 2, as well as the mean EQ-5D scores, were compared between the group with and that without sonographic evidence of endometriosis using logistic regression analysis, and multivariable analysis was used to adjust for demographic and clinical variables.</p><p><strong>Results: </strong>A total of 514 women were included in the final study population, of whom 146 (28.4%) were diagnosed with deep or ovarian endometriosis on TVS. On multivariable analysis, the presence of moderate-to-severe dyspareunia was not found to be associated with endometriosis. Moderate-to-severe dyspareunia was significantly associated with lower age (odds ratio (OR), 0.70 (95% CI, 0.56-0.89); P = 0.003) and a history of migraine (OR, 3.52 (95% CI, 1.42-8.77); P = 0.007), and it occurred significantly less frequently in women with non-endometriotic ovarian cysts (OR, 0.47 (95% CI, 0.28-0.78); P = 0.003). There was also a trend towards a positive association between anxiety/depression and moderate-to-severe dyspareunia (OR, 1.94 (95% CI, 0.93-4.03); P = 0.08). Following multivariable analysis, the only symptoms that were significantly more common in women with endometriosis compared to those without were menstrual dyschezia (OR, 2.44 (95% CI, 1.59-3.78); P < 0.001) and difficulty emptying the bladder (OR, 2.56 (95% CI, 1.52-4.31); P < 0.001). Although not reaching statistical significance on multivariable","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"372-383"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiomics analysis of ultrasound images to discriminate between benign and malignant adnexal masses with solid morphology on ultrasound.","authors":"F Moro, M Vagni, H E Tran, F Bernardini, F Mascilini, F Ciccarone, C Nero, D Giannarelli, L Boldrini, A Fagotti, G Scambia, L Valentin, A C Testa","doi":"10.1002/uog.27680","DOIUrl":"10.1002/uog.27680","url":null,"abstract":"<p><strong>Objective: </strong>The primary aim was to identify radiomics ultrasound features that can distinguish between benign and malignant adnexal masses with solid ultrasound morphology, and between primary malignant (including borderline and primary invasive) and metastatic solid ovarian masses, and to develop ultrasound-based machine learning models that include radiomics features to discriminate between benign and malignant solid adnexal masses. The secondary aim was to compare the discrimination performance of our newly developed radiomics models with that of the Assessment of Different NEoplasias in the adneXa (ADNEX) model and that of subjective assessment by an experienced ultrasound examiner.</p><p><strong>Methods: </strong>This was a retrospective, observational single-center study conducted at Fondazione Policlinico Universitario A. Gemelli IRCC, in Rome, Italy. Included were patients with a histological diagnosis of an adnexal tumor with solid morphology according to International Ovarian Tumor Analysis (IOTA) terminology at preoperative ultrasound examination performed in 2014-2020, who were managed with surgery. The patient cohort was split randomly into training and validation sets at a ratio of 70:30 and with the same proportion of benign and malignant tumors in the two subsets, with malignant tumors including borderline, primary invasive and metastatic tumors. We extracted 68 radiomics features, belonging to two different families: intensity-based statistical features and textural features. Models to predict malignancy were built based on a random forest classifier, fine-tuned using 5-fold cross-validation over the training set, and tested on the held-out validation set. The variables used in model-building were patient age and radiomics features that were statistically significantly different between benign and malignant adnexal masses and assessed as not redundant based on the Pearson correlation coefficient. We evaluated the discriminative ability of the models and compared it to that of the ADNEX model and that of subjective assessment by an experienced ultrasound examiner using the area under the receiver-operating-characteristics curve (AUC) and classification performance by calculating sensitivity and specificity.</p><p><strong>Results: </strong>In total, 326 patients were included and 775 preoperative ultrasound images were analyzed. Of the 68 radiomics features extracted, 52 differed statistically significantly between benign and malignant tumors in the training set, and 18 uncorrelated features were selected for inclusion in model-building. The same 52 radiomics features differed significantly between benign, primary malignant and metastatic tumors. However, the values of the features manifested overlapped between primary malignant and metastatic tumors and did not differ significantly between them. In the validation set, 25/98 (25.5%) tumors were benign and 73/98 (74.5%) were malignant (6 borderline, 57 primary inv","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"353-363"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angiogenic factors alone or in combination with ultrasound Doppler criteria for risk classification among late-onset small fetuses with or without pre-eclampsia.","authors":"L Youssef, F Crispi, S Paolucci, J Miranda, S Lobmaier, F Crovetto, F Figueras, E Gratacos","doi":"10.1002/uog.29181","DOIUrl":"10.1002/uog.29181","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the prognostic value of maternal angiogenic factors in late-onset small fetuses, alone or in combination with the ultrasound and Doppler parameters currently used for the classification of low-risk small-for-gestational-age (SGA) fetuses or high-risk fetal growth restriction (FGR), overall and according to the presence or absence of pre-eclampsia.</p><p><strong>Methods: </strong>This was a prospective cohort study of women with a singleton pregnancy with a diagnosis of late-onset fetal smallness (defined as birth weight < 10<sup>th</sup> centile) and a gestational age of ≥ 34 weeks at delivery. Ultrasound assessment of estimated fetal weight (EFW) and Doppler assessment of uterine artery pulsatility index (UtA-PI) and cerebroplacental ratio (CPR) were performed every 1-2 weeks. Biochemical analysis of the angiogenic factors placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) in maternal peripheral venous blood samples was performed using enzyme-linked immunosorbent assay within 1-2 weeks after diagnosis of SGA or FGR. The primary outcome was adverse perinatal outcome, defined as a composite of emergency Cesarean section for non-reassuring fetal status, metabolic acidosis (umbilical artery pH < 7.0), neonatal unit admission and/or perinatal death. The predictive value of EFW < 3<sup>rd</sup> centile, Doppler parameters (UtA-PI > 95<sup>th</sup> centile and CPR < 5<sup>th</sup> centile) and sFlt-1/PlGF ratio > 95<sup>th</sup> centile, alone or in combination, was assessed using logistic regression analysis in the overall population and stratified by presence or absence of pre-eclampsia developing at any time before delivery.</p><p><strong>Results: </strong>Among the 602 included cases, 91 (15.1%) developed pre-eclampsia and 511 (84.9%) did not. In the overall study population, all parameters were associated independently with adverse perinatal outcome: EFW < 3<sup>rd</sup> centile (adjusted odds ratio (aOR), 2.58 (95% CI, 1.67-4.00)), UtA-PI > 95<sup>th</sup> centile (aOR, 1.92 (95% CI, 1.25-2.94)), CPR < 5<sup>th</sup> centile (aOR, 2.35 (95% CI, 1.46-3.78)) and sFlt-1/PlGF ratio > 95<sup>th</sup> centile (aOR, 1.71 (95% CI, 1.09-2.69)). Only sFlt-1/PlGF ratio > 95<sup>th</sup> centile was associated independently with adverse perinatal outcome in cases with pre-eclampsia, whereas in those without pre-eclampsia, only EFW < 3<sup>rd</sup> centile and CPR < 5<sup>th</sup> centile were associated independently with adverse perinatal outcome. In the overall population, the detection rate (DR) and false-positive rate for adverse perinatal outcome were, respectively: 39.8% (95% CI, 31.7-47.9%) and 16.9% (95% CI, 10.7-23.1%) for sFlt-1/PlGF ratio > 95<sup>th</sup> centile alone; 86.8% (95% CI, 83.4-90.2%) and 61.9% (95% CI, 57.1-66.7%) for a combined model of EFW < 3<sup>rd</sup> centile, UtA-PI > 95<sup>th</sup> centile and CPR < 5<sup>th</sup> centile; 81.3% (95% CI, 77.3-85.3%) a","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"317-324"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply.","authors":"M L Larsen, S Kumar","doi":"10.1002/uog.29157","DOIUrl":"10.1002/uog.29157","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"394"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prenatal diagnosis of duplicated gallbladder: two-dimensional and three-dimensional ultrasound imaging and reconstruction.","authors":"G H A S Pacheco, P T Castro, G Tonni, H Werner, E Araujo Júnior","doi":"10.1002/uog.29173","DOIUrl":"https://doi.org/10.1002/uog.29173","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}