The Annals of otology, rhinology, and laryngology最新文献

{"title":"The Development and Validation of Novel 3-Dimensional Models for Simulation Training in Sinonasal and Skull Base Surgery.","authors":"Umar Rehman, Saleh Okhovat, Robbie Woods, Nyall R London, Benjamin Verillaud, Christian von Buchwald, Gary L Gallia, Sacit Bulent Omay, Warren Bennett, Kumar Abhinav, Garret Choby, Jayakar V Nayak, Samuel C Leong, Erich Vyskocil, Matt Lechner","doi":"10.1177/00034894251340879","DOIUrl":"https://doi.org/10.1177/00034894251340879","url":null,"abstract":"<p><strong>Introduction: </strong>As the demand for otolaryngologists increases, there is a need to address workforce and training challenges. Technological advancements, such as high-fidelity 3-dimensional (3D) simulations, may help train the future workforce-particularly for conditions with limited exposure, such as sinonasal and skull base cancers.</p><p><strong>Aims: </strong>This study aimed to develop and validate a high-fidelity head and neck model, created using proprietary 3D printing technology, to simulate sinonasal and skull base surgery.</p><p><strong>Methodology: </strong>The sinonasal and skull base models were designed and produced using proprietary 3D printing technology (Fusetec). 3D printed models were incorporated into a 2-day dissection course. Surveys were completed by delegates and faculty on the course, with delegates having their surgical performance assessed using the Objective Structures Assessment of Technical Skills (OSATS).</p><p><strong>Results: </strong>A total of 21 delegates and 10 faculty had utilized the 3D printed models for sinonasal and skull base surgery training. Overall, 71.4% of delegates (n = 15) and 70.0% (n = 7) of faculty rated the realism of the models as very good/excellent. The mean pre course OSATS score was 22.57/40 (SD ±6.88) and the post course OSATS score was seen to be 25.7/40 (SD ±4.70; <i>P</i> < .0001). The total confidence reported by delegates prior to the course was 25.8/45 (SD ±7.00) and following the course the self-reported confidence was 33.6/45 (SD ±3.62; <i>P</i> < .001).</p><p><strong>Conclusion: </strong>This study developed and validated a novel 3D model for simulating sinonasal and skull base surgery, which improved surgical performance amongst participants. This offers a potential training solution to address workforce challenges in Otolaryngology.</p>","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"34894251340879"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164624","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":"Audiological Outcomes in Mild to Moderate Post-COVID-19 Patients: A Longitudinal Study in a South Indian Tertiary Care Hospital.","authors":"Marina Saldanha, Jim Saroj Winston, Neema Kuniyil, Ananya Shree Poral","doi":"10.1177/00034894251341112","DOIUrl":"https://doi.org/10.1177/00034894251341112","url":null,"abstract":"<p><strong>Objective: </strong>The audio-vestibular symptoms commonly reported after COVID-19 usually presents within 6 weeks post infection. This study aimed to assess the effect of COVID-19 infection on the auditory status.</p><p><strong>Methods: </strong>This longitudinal prospective study included 74 patients diagnosed with mild to moderate COVID- 19 infection using PCR. Audiological assessment using Pure tone audiometry (PTA), speech audiometry, immittance evaluation, and transient evoked otoacoustic emissions (TEOAE) were done at 2 weeks post infection and 4 weeks following.</p><p><strong>Results: </strong>PTA showed a significant difference in the AC thresholds but not for the BC thresholds across 2 visits. Impedance audiometry revealed a significant difference over 2 visits for A tympanogram (<i>P</i> = .006). TEOAE was affected only at 1000 Hz (<i>P</i> < .05)Conclusion:Audio-vestibular symptoms are infrequent in COVID-19 infection. There is a conductive nature of hearing impairment, as evidenced in the initial and follow-up evaluations. The TEOAE changes at 1000 Hz raises the possibility of subclinical cochlear involvement.</p>","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"34894251341112"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145402","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":"Surgical Treatment Outcomes in the Management of Rhinitis: A Systematic Review and Meta-Analysis.","authors":"Asher T Ripp, Pranav A Patel, Shaun A Nguyen, Isabella V Schafer, Alexander N Duffy, Zachary M Soler, Rodney J Schlosser","doi":"10.1177/00034894251341110","DOIUrl":"https://doi.org/10.1177/00034894251341110","url":null,"abstract":"<p><strong>Background: </strong>Rhinitis can present with symptoms including severe nasal obstruction, rhinorrhea, nasal itching, and sneezing. Surgical treatment options include inferior turbinate procedures, thought to target nasal congestion, and posterior nasal nerve (PNN) procedures, for relief of rhinorrhea. This review intends to quantify the degree of resolution of symptoms related to rhinitis from various procedures and guide clinical decision making.</p><p><strong>Methods: </strong>A literature search identified studies reporting rhinitis symptoms at baseline and following surgical treatment. Outcomes of interest were the 4-item Total Nasal Symptom Score (TNSS) and VAS equivalents for \"rhinorrhea,\" \"nasal obstruction,\" \"nasal itching,\" and \"sneezing.\" Postnasal drip (PND) scores were additionally collected when available.</p><p><strong>Results: </strong>A total of 20 studies (N = 1408) were analyzed. The TNSS fell by 50% (mean difference 3.86 points [95% CI 3.03-4.69]), with all 4 symptoms undergoing significant amelioration across all procedure types. Nasal congestion, rhinorrhea, and PND saw the largest improvement, with reductions ranging from 1.2 to 1.5 points. VAS scoring followed a similar pattern, with nasal obstruction and runny nose undergoing the largest changes. Turbinate and PNN procedures led to similar improvements in congestion and rhinorrhea, with average score reductions of 56.8% and 57.6% (<i>P</i> = 0.7168), respectively. Nasal itching and PND underwent differential improvement, with greatest improvements from PNN procedures (mean differences of 14.2% [95% CI: 4.7-23.4%<b>]</b> and 31.6% [95% CI: 21.2-40.6%], <i>P</i> < .0001).</p><p><strong>Conclusion: </strong>All surgical treatments for rhinitis improve patient symptom burden, having the most drastic effect on nasal congestion and rhinorrhea. PNN procedures result in greater improvements in nasal itching and PND but otherwise perform similarly to inferior turbinate surgeries.</p>","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"34894251341110"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145403","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":"Health-Related Quality of Life Metrics in Patients With Retrograde Cricopharyngeus Dysfunction.","authors":"Daniel Jacobs, Julia E Duffy, Benjamin A Lerner, Michael Z Lerner","doi":"10.1177/00034894251342088","DOIUrl":"https://doi.org/10.1177/00034894251342088","url":null,"abstract":"<p><strong>Objective: </strong>We sought to objectively characterize functional quality of life and social anxiety metrics in patients with retrograde - cricopharyngeus dysfunction (R-CPD) using validated questionnaires.</p><p><strong>Methods: </strong>A survey was posted to a private R-CPD Facebook group and a public R-CPD Reddit group. The survey contained demographic and clinical questions, as well as the PROMIS-29 questionnaire and the Social Anxiety Questionnaire (SAQ). The PROMIS-29 questionnaire contains 7 subdomains of quality of life functioning and is scored against a national average. The SAQ is a 30-item questionnaire with 5 subdomains of social anxiety. Comparisons of means were performed using <i>t</i>-tests and logistic regressions.</p><p><strong>Results: </strong>Survey results from 239 respondents were included. The majority of respondents were young (<30 years, 51.1%) and female (73.6%). Two hundred twenty (92.1%) reported all 3 cardinal R-CPD symptoms and were included in the analysis of PROMIS-29 and SAQ results. On the PROMIS-29 questionnaire, respondents reported high levels of anxiety (71.0%), depression (55.1%), fatigue (66.8%), sleep impairment (43.0%), social avoidance (54.3%), and pain impairment (58.8%). The mean SAQ score was 96.4, with 52.0% of respondents scoring above the cutoff for social anxiety. Reported anxiety was highest in interactions with strangers (71.1%, 95% confidence interval [CI]: 64.3%-77.9%) and lowest in interactions with the sex 1 is attracted to (44.5%, 95% CI: 37.0%-52.0%).</p><p><strong>Conclusions: </strong>Patients with R-CPD have high levels of anxiety and other impairment. Results may help clinicians understand and treat patients with R-CPD, and provide benchmarks by which clinicians may better monitor response to therapy, and provide benchmarks for clinicians to better monitor therapy response.</p>","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"34894251342088"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152571","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":"The Influences of Nasal Saline Irrigation on Chinese Children with Allergic Rhinitis Plus Asthma.","authors":"Xiaofang Ji","doi":"10.1177/00034894251340877","DOIUrl":"https://doi.org/10.1177/00034894251340877","url":null,"abstract":"<p><strong>Objective: </strong>To determine the influence of nasal saline irrigation on Chinese pediatric patients with allergic rhinitis plus asthma.</p><p><strong>Methods: </strong>An attempt was made to randomly categorize 60 pediatric patients with allergic rhinitis plus asthma, who were admitted to our hospital (June 2022-March 2023), into 2 groups (n = 30). Participants in the 2 groups were given routine treatment for allergic rhinitis plus asthma, while those in the observation group were additionally administered nasal saline irrigation. Thereafter, the overall effective rate, total adverse reaction rate, nasal sign scores, childhood asthma control test (C-ACT) scores, total nasal symptom scores (TNSS), airway inflammation index (fractional exhaled nitric oxide, FENO), and allergy indices (Total serum IgE, TIgE; eosinophils, EOS) underwent comparative analysis before and after the treatment between the 2 principal groups.</p><p><strong>Results: </strong>A significantly escalated overall effective rate was noted in the observation group relative to the control group (<i>P</i> = .023). The lack of a significant difference, particularly in the total adverse reaction rate, was noteworthy between the 2 principal groups (<i>P</i> = 0.640). A comparable analysis of nasal sign scores, C-ACT score, TNSS score, FENO, and allergy indices was conducted between the 2 groups before treatment, which showed a lack of significant differences. Significantly attenuated nasal sign scores, TNSS score, FENO, and allergy indices were observed in the observation group following treatment, relative to both the control group and pre-treatment levels. Significantly elevated C-ACT scores were also noted compared to both the control group and pre-treatment levels (<i>P</i> = .019).</p><p><strong>Conclusion: </strong>Nasal saline irrigation proved remarkably effective, particularly in Chinese pediatric patients with allergic rhinitis plus asthma, showing advantages in alleviating disease-related symptoms and signs, reducing airway inflammation, and diminishing the severity of allergic reactions.</p>","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"34894251340877"},"PeriodicalIF":0.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136610","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":"Middle Ear Cleft Opacification in Acute Otitis Externa: Sequela or Incidentaloma?","authors":"Roni Barzilai, Goni Merhav, Mauricio Cohen-Vaizer, Roee Noy, Natalia Gvozdev, Ayelet Eran, Yona Vaisbuch","doi":"10.1177/00034894251343165","DOIUrl":"https://doi.org/10.1177/00034894251343165","url":null,"abstract":"<p><strong>Background: </strong>The external and middle ear are anatomically distinct regions. Middle ear cleft opacification (MECO) observed following acute otitis externa (AOE) raises questions about its occurrence mechanism and clinical significance. Previous animal studies have demonstrated that irritation of the external ear canal can lead to the development of middle ear effusion via Pars Flaccida cells. The literature lacks clinical information on middle ear involvement in AOE.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 92 patients post-AOE who underwent brain imaging within 3 months post-uncomplicated AOE. Patients with anatomical disruptions between the external and middle ear were excluded. MECO rate and dynamics were evaluated. The involvement of middle ear cleft anatomic regions was assessed.</p><p><strong>Results: </strong>MECO was identified in 38.0% (35/92) of post-AOE ears compared to 10.8% (10/92) of contralateral ears (<i>P</i> = .002). The prevalence of MECO in post-AOE patients decreased from 58.9% (23/39) within 2 weeks post-AOE to 8.0% (2/25) 3 months post-AOE. Over time, complete middle ear opacification gradually transitioned to partial opacification. Opacification was noted in the upper middle ear cleft (epitympanum/mastoid) in 94.2% (33/35).</p><p><strong>Conclusions: </strong>Middle ear effusion is a common, resolving sequela of AOE, rather than an indication of AOE deterioration or significant middle ear inflammatory involvement. This information is valuable for otolaryngologists as well as general practitioners who treat AOE patients, helping to better understand potential sequelae and avoid unnecessary treatments, and for radiologists who diagnose ME opacification in AOE patients. Further studies are warranted to explore the role of the pars flaccida in middle ear effusion.</p>","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"34894251343165"},"PeriodicalIF":0.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136630","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":"Response Letter to Editor Letter From 26th February 2025 on \"A Retrospective Single-Center Study in 20 Patients With Midline Nasal Masses: Which Site Has the Highest Risk of Recurrence?\"","authors":"Miray-Su Yılmaz Topçuoğlu, Peter K Plinkert, Angelika Seitz, Ahmed El Damaty, Heidrun Bächli, Ingo Baumann","doi":"10.1177/00034894251340873","DOIUrl":"https://doi.org/10.1177/00034894251340873","url":null,"abstract":"","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"34894251340873"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136631","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":"Letter to the Editor on \"A Retrospective Single-Center Study in 20 Patients With Midline Nasal Masses: Which Site Has the Highest Risk of Recurrence?\"","authors":"Kirubhagaran Ravichandran","doi":"10.1177/00034894251328763","DOIUrl":"https://doi.org/10.1177/00034894251328763","url":null,"abstract":"","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"34894251328763"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136628","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":"Environmental Impact of Flexible Single-Use and Reusable Video Laryngoscopes.","authors":"Luke J Pasick, Jake Langlie, Pavan S Krishnan, Eve R Bowers, David E Rosow","doi":"10.1177/00034894251341111","DOIUrl":"https://doi.org/10.1177/00034894251341111","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to evaluate and compare the environmental impact of single-use and reusable video laryngoscopes.</p><p><strong>Methods: </strong>We performed life-cycle assessments of video laryngoscopes at a tertiary-care academic center: single-use Ambu aScope 4 RhinoLaryngo Slim (Ambu Inc., Columbia, MD), single-use Video Rhino-Laryngoscope (Karl Storz, Tuttlingen, Germany), and reusable Storz Video Rhinolaryngoscope 1101HD. We collected data regarding lifecycle, manual reprocessing, and waste disposal at our institution. The lifetime carbon footprint of each device was calculated and included emissions related to manufacturing, transportation, sterilization, repair, and disposal. We then assessed carbon footprint of each device per procedure.</p><p><strong>Results: </strong>The total estimated carbon footprint per procedure for single-use Ambu and Storz laryngoscopes is 7.46 and 5.49 kg CO₂, respectively. The mass of solid waste of single-use laryngoscopes and packaging contribute to carbon emissions of 0.173 and 0.40 kg CO₂ for Ambu and Storz laryngoscopes, respectively. Reusable laryngoscopes are estimated to have a carbon footprint of 0.1137 kg CO₂ per procedure at our institution. The greatest contributions to carbon footprint during reusable laryngoscope manual reprocessing include personal protective equipment solid waste and electrical energy (0.0859 and 0.016 kg CO₂, respectively). The carbon footprint of single-use laryngoscopes is estimated to range from 1.5-fold (based on solid waste alone) up to 66-fold greater than traditional reusable laryngoscopes, although the use of water and chemicals for reprocessing must also be considered.</p><p><strong>Discussion: </strong>While single-use laryngoscopes have benefits of added convenience, cost effectiveness, and ease of use, they have a significantly greater environmental impact than resusable laryngoscopes. Otolaryngologists should consider the environmental impact of single-use laryngoscopes with goals of improving carbon footprint reduction.</p>","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"34894251341111"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121991","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":"Incidentalomas in Paranasal Sinus Computed Tomographic Imaging: Frequency and Characteristics.","authors":"Marta M Williams, Samantha M Shave, Margaret B Mitchell, Ryan A Bartholomew, Neil Bhattacharyya","doi":"10.1177/00034894251339894","DOIUrl":"https://doi.org/10.1177/00034894251339894","url":null,"abstract":"<p><strong>Objectives: </strong>As patient access to radiology reports increases, incidental findings can be a significant source of stress and an increasing burden for clinicians to address. This study analyzes the frequency and characteristics of incidental findings on paranasal sinus computed tomography (CT) scans.</p><p><strong>Methods: </strong>A retrospective review of a random sample of radiology reports for paranasal sinus CT scans in a metropolitan healthcare system in 2021 was conducted. Incidental findings were defined as unexpected findings which an otolaryngologist would not typically manage or would evaluate using different diagnostic modalities. Incidental findings were categorized based on anatomic location and etiology. Associations between incidental findings with age and sex were examined.</p><p><strong>Results: </strong>Among 1000 scans, 385 (38.5%) yielded at least 1 incidental finding. Of these, 66% contained 1 incidental finding, 31% had 2 or 3 incidental findings, and 4% had 4 to 6 incidental findings (mean number of incidental findings = 1.5). Among incidental findings, 34.8% were dental-related, followed by 19.9% vascular, 15.3% intracranial, 11.2% unexpected non-sinonasal mass, 7.8% spine, 6.6% otologic/temporal bone, 1.5% orbit/ophthalmologic, 1.4% lymphadenopathy, and 1% thoracic-related. Increasing age was associated with incidental findings (mean age with incidental findings, 59.7 years vs 49.7 years without; <i>P</i> < .001). Sex was not associated with the presence of incidental findings (<i>P</i> = .583). Importantly, 3.4% of findings were considered potentially clinically serious.</p><p><strong>Conclusion: </strong>Incidental findings are frequently reported on sinus CT scans, though the vast majority are not considered potentially serious. Further refinement of systems for denoting their clinical significance may minimize the burden for clinicians and worry for patients.</p>","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"34894251339894"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122001","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}