N.N. Priorov Journal of Traumatology and Orthopedics最新文献

{"title":"Success predictors of decompressive surgical treatment for lumbar degenerative spinal canal stenosis","authors":"A. Krutko, A. G. Nazarenko, G. E. Balychev, E. Baykov, O.I. Leonova","doi":"10.17816/vto623807","DOIUrl":"https://doi.org/10.17816/vto623807","url":null,"abstract":"BACKGROUND: Decompressive surgical treatment for degenerative lumbar stenosis significantly improves patient clinical status. However, in some cases, patients are not satisfied with the outcomes. Various studies have examined clinical and morphological factors to improve the results of surgical interventions. \u0000AIM: To identify clinical and morphological predictors of the success of decompressive surgical interventions for lumbar degenerative stenosis. \u0000MATERIALS AND METHODS: This retrospective study included 61 patients who underwent surgery for mono- and postsegmental lumbar degenerative stenosis. Clinical and demographic data and the stage of degenerative changes in the functional spinal unit and sagittal balance of the spine were assessed. The success of surgical treatment was defined as simultaneous compliance with three criteria after 6–18 months: achievement of MCID for ODI (≥12%), recalibration of the spinal canal at the level of intervention according to MRI data (Schizas regression to ≥1 stage), and improvement of the patient’s subjective feeling (4–5 on the Likert scale). Logistic regression analysis was used to identify predictors of treatment outcome. \u0000RESULTS: A significant decrease in the intensity of pain syndrome (VAS in back and leg) and an improvement in the quality of life (ODI) after surgery (p 0.001) were found in all patients. In 73.8% of cases, the MCID threshold exceeded for ODI, whereas in 75.41%, patients were satisfied with surgical treatment. The success rate of surgical intervention was 65.57%. In one-factor regression analysis of clinical, demographic, and morphological parameters, the only independent predictor of surgical treatment was neuropathic pain before surgery according to the DN4 questionnaire (OR=1.52; p=0.011). \u0000CONCLUSION: Decompressive surgical treatment for degenerative lumbar stenosis is an effective treatment method, regardless of the extent and degree of degenerative changes in the spinal–motor segments and concomitant degenerative pathology, including disruption of sagittal balance. The predicting factor of the success of decompressive intervention is the severity of preoperative neuropathic pain.","PeriodicalId":308632,"journal":{"name":"N.N. Priorov Journal of Traumatology and Orthopedics","volume":"52 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140655707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality in fracture of the distal femoral bone (review)","authors":"Kymbatbek R. Shermatov, M. V. Parshikov, Kamal M. Medjidov","doi":"10.17816/vto582010","DOIUrl":"https://doi.org/10.17816/vto582010","url":null,"abstract":"Distal femur fractures in the elderly can lead to the exacerbation of chronic diseases and fatal outcomes similar to those observed in femoral neck fractures in the same category of individuals. Thus, this study aimed to determine the factors influencing the mortality of patients with distal femur fractures based on the analysis of foreign studies and results of treated patients. Review of foreign literature was conducted using the databases of medical publications PubMed, CyberLeninka, Google Scholar, Scopus, Medline, and Cochrane among articles in English, Chinese, Italian, and Russian, as well as through the Web of Knowledge. We analyzed publications for the last 10 years. Evaluation of treated patients included patients aged 60 years with distal femoral fractures between 2021 and 2023. Analysis of the literature data showed that distal femur fractures are accompanied by high mortality in patients in the first years after injury (from 18% to 35%), commonly in elderly patients without surgical treatment (90%–100%), and the presence of several concomitant diseases accompanied by contractures of the femur, knee joint, and false joint and displacement or fracture of the metal retainer. Early surgical treatment (first 48 h) is an effective treatment method that significantly reduces mortality after distal femur fracture (by 2.8 times).","PeriodicalId":308632,"journal":{"name":"N.N. Priorov Journal of Traumatology and Orthopedics","volume":"3 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140653330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring shoulder joint pain: a comparative analysis of dynamic ultrasonography and magnetic resonance imaging","authors":"Sparsh Varma, Praveen K Sharma, Afwaan Faizal, Ajay Lucas","doi":"10.17816/vto626367","DOIUrl":"https://doi.org/10.17816/vto626367","url":null,"abstract":"BACKGROUND: To evaluate shoulder joint pain, the study concentrated on evaluating the diagnostic accuracy of ultrasonography and magnetic resonance imaging. \u0000AIM: By comparing the results from both modalities within the same patient group, the study aimed to identify potential challenges in image interpretation, underscoring the limitations of ultrasonography and magnetic resonance imaging. \u0000MATERIALS AND METHODS: Patients with shoulder joint pain were included through purposive sampling. These patients underwent ultrasonography and magnetic resonance imaging, and the results were correlated. Various shoulder pathologies, including tendon tears, bursitis, degenerative changes, calcifications, and impingement, were analyzed. \u0000RESULTS: The study comprised 35 patients who underwent ultrasonography and magnetic resonance imaging detecting pathologies such as subscapularis and supraspinatus tendon injuries, partial and full-thickness tears, peribicipital tendon fluid, subcoracoid and subacromial-subdeltoid bursitis, acromioclavicular joint degeneration, tendon calcification, and impingement. Comparative analysis showed varying sensitivities, specificities, positive predictive values, negative predictive values, and accuracy for different pathologies. \u0000CONCLUSION: Compared with ultrasonography, magnetic resonance imaging demonstrated greater sensitivity and specificity in identifying conditions causing shoulder pain. Ultrasonography’s affordability, real-time capabilities, and ability to compare results with the unaffected side make it a useful first diagnostic step for shoulder pain. Ultrasonography, although a quick and cost-effective initial diagnostic tool, has limitations, including operator dependence and lower sensitivity in certain conditions. In contrast, magnetic resonance imaging is employed as a confirming measure or in instances where diagnosis is challenging. The study emphasized the complementary roles of ultrasonography and magnetic resonance imaging in the diagnosis of shoulder joint pain, with magnetic resonance imaging as the more accurate and complete imaging modality.","PeriodicalId":308632,"journal":{"name":"N.N. Priorov Journal of Traumatology and Orthopedics","volume":"36 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140657644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical and functional guidelines for the correction hindfoot malalignment","authors":"K. V. Shkuro, V. T. Zeinalov, I. Arapova, Andrej N. Levin, D. O. Vasiliev","doi":"10.17816/vto321523","DOIUrl":"https://doi.org/10.17816/vto321523","url":null,"abstract":"BACKGROUND: The techniques for the surgical correction of a hindfoot valgus deformity usually include both bony and soft-tissue techniques, depending on the deformity severity. Medializing calcaneal osteotomy (MCO) is one of the main surgical techniques used to correct such deformities. However, the degree of deformity in different patients can vary significantly; thus, using the above principle, the degree of calcaneal postoperative correction can vary considerably. Based on data from various authors, patients with an insufficient correction of the heel bone axis have a residual valgus in the hindfoot. However, the lack of complete correction may result in the persistence of complaints and corrected limb recurrence. \u0000OBJECTIVE: To improve the surgical treatment of hindfoot malalignment. \u0000MATERIAL AND METHODS: The study analyzed treatment results of patients with ankle sprain in the Center Traumatology and Orthopedics (Moscow) between 2012 and 2020. All implantations were performed by two surgeons. The total number of patients is 60. Fifty-five patients with follow-up periods of over 12 months after the procedure were available for a retrospective analysis and assessment of results. The study enrolled 20 men and 35 women, with a mean age of 61.6 (18,540,7) years years. The mean follow-up period is 62 (1880) months. \u0000RESULT: The mean change in the Foot and Ankle Outcome Score (FAOS) pain subscale was 27.9 (range, 8.3 to 63.9) for the moderate varus group (n = 16), 41.2 (range, 5.666.7) for the mild varus group (n = 17), and 22.3 (range, 58.3 to 63.9) for the valgus group (n = 18). In addition, patients with mild varus demonstrated better clinical outcomes than those with valgus; however, this difference was not statistically significant (p=0.11). No differences were found between groups in the change in scores for daily activities (p=0.26), sports activities (p=0.06), or quality of life (p=0.17) subscales of the FAOS. \u0000CONCLUSION: Patients with mild varus hindfoot alignment showed significantly greater improvement than those with valgus with respect to the FAOS pain subscale and significantly greater improvement than those with moderate varus in the FAOS symptoms subscale.","PeriodicalId":308632,"journal":{"name":"N.N. Priorov Journal of Traumatology and Orthopedics","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128735303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Os odontoideum of C2 vertebra: Aspects of epidemiology, etiopathogenesis, clinical manifestations, and diagnosis. Literature review","authors":"Vladislav A. Sharov, Alexander A. Kuleshov, A. N. Shkarubo, M. S. Vetrile, I. N. Lisyansky, S. N. Makarov","doi":"10.17816/vto121329","DOIUrl":"https://doi.org/10.17816/vto121329","url":null,"abstract":"We present a literature review devoted to the study of a craniovertebral malformation such as the os odontoideum of C2 vertebra. This is a rare anomaly that often results in atlantoaxial instability and, as a consequence, a wide range of clinical manifestations. The review is analytic and was conducted using medical literature databases and search resources, namely, PubMed (MEDLINE), Google Scholar, and eLibrary. The review focused on the definition of os odontoideum and its epidemiology, including the structure of craniovertebral junction pathologies. Features of the embryonic development of the craniovertebral junction, which are important in terms of the notion of the theories of the origin of os odontoideum, are described. The anatomical variants of the os odontoideum are presented, and a wide range of clinical manifestations of this pathological condition and approaches to its diagnosis are described.","PeriodicalId":308632,"journal":{"name":"N.N. Priorov Journal of Traumatology and Orthopedics","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121824978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the treatment results of humerus diaphysis post-traumatic false joints using vascularized bone grafts with and without a monitor skin flap: Retrospective cohort study","authors":"I. Golubev, A. Sarukhanyan, M. Merkulov, O. Bushuev, G. N. Shiryaeva, I. Kutepov, Vasiliy D. Kuznetzov","doi":"10.17816/vto321388","DOIUrl":"https://doi.org/10.17816/vto321388","url":null,"abstract":"BACKGROUND: The use of the microvascular flap in reconstructive surgery of complicated nonunions of the diaphysis of the humerus is highly valuable. Flaps with compromised blood supply are possible in up to 10% of cases and often lead to the failure of vascularized reconstruction. The combined skin + bone graft is a simple, useful, and reliable option for flap vitality control with a high success rate. \u0000OBJECTIVE: To compare microvascular grafting with versus without monitoring the skin flap. \u0000MATERIALS AND METHODS: Forty-one microvascular grafting was performed from 2010 to 2017 in patients with humeral non-union and bone defects in the Department of Microsurgery and Trauma of the Hand of Priorov National Medical Research Center of Traumatology and Orthopedics. A combined skin bone flap was used in 23 (56%) patients, and in 18 (44%) patients, grafting was performed without monitoring the skin flap Computed tomography and X-ray imaging were used to monitor non-union healing. The use of a signal skin flap is an effective way to control blood flow in the graft and improves treatment results. \u0000RESULTS: In the group without monitoring of the skin flap, non-union healing was documented in 14 (77%) cases. In the group with monitoring of the skin flap, nonunion healing occurred in 22 (96%) cases. \u0000CONCLUSION: Monitoring the skin flap is an effective option to ensure microvascular flap blood supply control and improves the outcomes in humeral nonunion healing.","PeriodicalId":308632,"journal":{"name":"N.N. Priorov Journal of Traumatology and Orthopedics","volume":"164 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121348770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of endoscopic transnasal and microsurgical transoral odontoidectomy: Literature review and own experience","authors":"A. N. Shkarubo, Anton G. Nazarenko, I. Chernov, D. Andreev, Alexander A. Kuleshov, Nikolai A. Konovalov, I. Lisyanskiy, M. Sinelnikov","doi":"10.17816/vto321930","DOIUrl":"https://doi.org/10.17816/vto321930","url":null,"abstract":"BACKGROUND: Odontoidectomy is indicated in the case of anterior compression of brainstem structures by an invaginated dentoid process, and it is currently possible to perform both transoral microsurgical and transnasal endoscopic access. \u0000OBJECTIVE: To conduct a comparative analysis of endoscopic transnasal and microsurgical transoral odontoidectomy performed by the first author. \u0000MATERIALS AND METHODS: The treatment results of 29 patients with pathological conditions, including anterior compression of stem structures with an invaginated dentoid process, were analyzed. Of 29 patients, 5 (17%) underwent surgery transnasally endoscopically, and 24 (83%) underwent surgery transorally microsurgically. \u0000RESULTS: Decompression of brainstem structures was achieved in all cases. The absence of the need to install a tracheostomy before surgery and the smaller volume of oropharyngeal trauma allow patients to undergo transnasal removal of the dentoid process and endure the postoperative period easier and faster. \u0000CONCLUSION: Currently, endoscopic transnasal access is gradually replacing transoral access in certain patients who are indicated for anterior odontoidectomy. Moreover, the literature analysis shows an ever deeper development of this technique; however, unambiguous indications of the use of transoral or transnasal access have not been formed at present.","PeriodicalId":308632,"journal":{"name":"N.N. Priorov Journal of Traumatology and Orthopedics","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116914336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regenerative medicine and orthobiological drugs possibilities in upper limb diseases treatment: Literature review","authors":"A. Greben, P. Eremin, Juliya V. Byalik, E. Kostromina, G. K. Parsadanyan, P. A. Markov, Aleksei V. Afanasiev, T. N. Greben","doi":"10.17816/vto322818","DOIUrl":"https://doi.org/10.17816/vto322818","url":null,"abstract":"The analyses of regenerative medicine progress, stem cell biology, and platelet rich plasma growth factor mechanisms of action have pushed many researchers to use orthobiological drugs in their clinical practice. This review aimed to present the use of regenerative techniques and orthobiological drugs in the treatment of upper limb diseases. The open electronic database of PubMed (MEDLINE) was used in the search for scientific studies. The literature search was conducted using the keywords regenerative medicine, orthobiology, hand, wrist joint, platelet rich plasma, mesenchymal stem cells, and stromal-vascular function. The article presents the results and rationale of the use of orthobiological drugs in the treatment of various hand and upper limb pathologies. The use of orthobiological drugs and regenerative techniques in the treatment of upper limb diseases is a safe and promising direction. For the subsequent use of effective cell products, further research is needed to assess their long-term results and development of unified protocols for their use.","PeriodicalId":308632,"journal":{"name":"N.N. Priorov Journal of Traumatology and Orthopedics","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128271234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Registration and analysis of complications in the neurosurgical clinic","authors":"Dmitry Y. Usachev, A. Nazarenko, Nikolai A. Konovalov, S. Tanyashin, O. Sharipov, M. A. Shults, G. Danilov","doi":"10.17816/vto340878","DOIUrl":"https://doi.org/10.17816/vto340878","url":null,"abstract":"BACKGROUND: Currently, in medicine, including neurosurgery, systemic risk management to improve treatment quality is one of the most urgent tasks. The key indicators of treatment quality in neurosurgery are the characteristics of its outcomes, structure, and number of complications. \u0000OBJECTIVE: To formulate the most concise and complete definition of complication and develop a classification scheme that allows the maximum consideration of complications in patients with neurosurgical problems. \u0000MATERIALS AND METHODS: A neurosurgical complication was defined as any unwanted, unintended deviation from the ideal course of the treatment process for a patient with neurosurgical pathology. The study included patients operated on for neurosurgical pathology at the Center for Neurosurgery (Moscow) from January 2019 to December 2020. To record all complications, an electronic database was created, where information about all neurosurgical complications was entered. \u0000RESULTS. Based on the analysis of annual reports of medical and diagnostic departments, the average incidence of complications was 2529 per 1000 operations (2.52.9%). The study of neurosurgical complications made it possible to determine the general parameters that are of key importance for the registration and analysis of neurosurgical complications and formulate an original classification scheme, and its use makes it possible to consider most of the factors associated with complications and, accordingly, their analysis. \u0000CONCLUSION: In the literature analysis, a series of discussions within the neurosurgical community, and our experience, we proposed a definition of neurosurgical complication and an approach to registering complications. With the help of the proposed classification scheme, we could obtain objective data and conduct evidence-based analysis, which makes it possible to evaluate complications using a treatment quality control system by obtaining the most complete amount of data on complications in a neurosurgical clinic.","PeriodicalId":308632,"journal":{"name":"N.N. Priorov Journal of Traumatology and Orthopedics","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127708378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dyspareunia in pelvic ring in women","authors":"Y. Gudushauri, V. V. Konovalov, E. Solod, Malkhaz G. Kakabadze, Evgeniy I. Kalinin, I. N. Marychev","doi":"10.17816/vto321288","DOIUrl":"https://doi.org/10.17816/vto321288","url":null,"abstract":"BACKGROUND: Currently, researchers are interested in little-studied complications such as pain during intercourse, mainly in the pubic region, often combined with diastasis of the pubic symphysis. Our data and those of domestic and foreign authors presented the main problematic aspect, i.e., dysfunctions of the pubic symphysis. Literature data revealed the main reasons for the emergence of the above problems. The main complications of pelvic ring injuries, including sexual dysfunction in female patients, depending on the main causes, are considered. \u0000OBJECTIVE: To improve the results of the treatment of the structural and functional disorders of pubic articulation in women. \u0000MATERIALS AND METHODS: In the traumatology and orthopedic department No. 1 of the Priorov National Medical Research Center of Traumatology and Orthopedics (Moscow), 34 patients with pubic symphysis were examined. 26 (76.5%) patients underwent surgical treatment metallodesis of the anterior pelvic half-ring with a plate, along with a defect plasty with osteoplastic biocomposite material for chronic postpartum ruptures and post-traumatic injuries of the pubic symphysis. The Majeed rating scale was used to determine sexual dysfunction and evaluate pelvic ring function. \u0000RESULTS: Of 34 patients associated with chronic postpartum rupture or posttraumatic rupture of the pubic symphysis, 26 (76.5%) had sexual dysfunction; the time interval between natural childbirth and surgical treatment of the pelvic ring varied from 6 months to 10 years (mean 5.7 years), 12 (35.2%) patients developed moderate to severe accumulation symptoms from the lower urinary tract. 26 women underwent surgical intervention: metallodesis of the anterior pelvic half-ring which demonstrated the possibility of stopping dyspareunia. \u0000CONCLUSION: Vertical or horizontal instability of the anterior pelvic ring leads to pelvic diaphragm failure in women, which in most cases causes dyspareunia.","PeriodicalId":308632,"journal":{"name":"N.N. Priorov Journal of Traumatology and Orthopedics","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126488470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}