Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Anesthetic considerations in surgery for early onset scoliosis: Challenges and advancements","authors":"Shikha Jain ,&nbsp;Parin Lalwani ,&nbsp;Soumya Sarkar ,&nbsp;Anjaleekrishna K ,&nbsp;Puneet Khanna ,&nbsp;Zainab Ahmad","doi":"10.1016/j.jcot.2026.103374","DOIUrl":"10.1016/j.jcot.2026.103374","url":null,"abstract":"<div><div>Scoliosis correction surgery in pediatric patients poses complex anesthetic challenges due to significant anatomical deformities, cardiopulmonary compromise, and the potential for substantial blood loss. Patients frequently exhibit significant cardiopulmonary compromise due to severe thoracic curvature and rib cage distortion, which impairs pulmonary gas exchange and increases the likelihood of perioperative complications. The severity of Cobb's angle, the number of affected vertebrae, and coexisting syndromes like kyphoscoliosis influence these cardiopulmonary changes and can lead to abnormalities in the airway, craniofacial skeleton, neurological system, and genitourinary tract. Comprehensive perioperative management requires meticulous preoperative optimization, intraoperative vigilance, and multidisciplinary coordination.</div><div>Preoperative evaluation focuses on assessing respiratory function, cardiovascular adaptation, and identification of any associated syndromes that influence airway management and anesthetic planning. Intraoperatively, securing the airway despite distorted anatomy is critical; invasive monitoring, deliberate hypotension, and strategies to maintain normothermia are key adjuncts. Neuromonitoring, particularly somatosensory and motor evoked potentials, mandates careful anesthetic titration to preserve signal integrity while ensuring adequate analgesia and immobility. Blood conservation strategies including antifibrinolytics, cell salvage, and hemodilution are critical to minimize transfusion requirements.</div><div>Postoperative care has evolved significantly with adoption of Enhanced Recovery After Surgery (ERAS) protocols, tailored to pediatric populations undergoing extensive spinal correction. Postoperative concerns encompass respiratory failure, pain control through multimodal analgesia, and vigilance for neurological or hemodynamic deterioration. Employing regional techniques such as erector spinae plane blocks with opioid-sparing multimodal regimen helps ensure effective analgesia, reduce opioid-related side effects, and promote early mobilization, which is crucial for minimizing postoperative pulmonary complications and accelerating functional recovery.</div><div>An individualized, evidence-based anesthetic plan integrating optimized physiology, real-time neuromonitoring, and multidisciplinary collaboration is essential for improving safety and outcomes in pediatric scoliosis surgery. Emerging modalities, such as AI-assisted anesthesia and closed-loop systems show considerable promise for enhancing real-time monitoring, anticipating complications, and personalizing anesthetic delivery, thereby reducing human error and improving acre quality.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"74 ","pages":"Article 103374"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175470","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":"Computer assisted navigation in total shoulder arthroplasty","authors":"Tej Joshi,&nbsp;Swara R. Kalva,&nbsp;Dario Fucich,&nbsp;Roy Romem,&nbsp;Mandeep S. Virk","doi":"10.1016/j.jcot.2026.103359","DOIUrl":"10.1016/j.jcot.2026.103359","url":null,"abstract":"<div><div>The utilization of total shoulder arthroplasty has increased markedly over recent decades, owing to the introduction of reverse shoulder arthroplasty, modular and convertible components, and advances in preoperative planning and intraoperative guidance technology. Three-dimensional (3D) computed tomography (CT)–based planning software enables accurate assessment and correction of glenoid deformity and plan for individualized implant selection and templating. Guidance technology extends this capability into the operating room by allowing the surgeon to replicate the preoperative plan with precision and accuracy. Computer-assisted navigation (CAN) is a guidance technology that provides real-time intraoperative feedback to execute the preoperative plan. CAN is currently available for the glenoid component only and is particularly useful in complex primary and revision cases, providing improved accuracy and precision of glenoid component placement, and better short-term outcomes. Although the cost effectiveness, and long-term benefits on implant survivorship are unknown, CAN represents a safe and effective intraoperative guidance tool while maintaining low complication rates. In this review, we discuss the current status of CAN in shoulder arthroplasty including the surgical technique, and review of literature.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"74 ","pages":"Article 103359"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175083","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":"Robotic-assisted total knee arthroplasty for post-traumatic osteoarthritis following tibial plateau fractures: A narrative review","authors":"F. Granata ,&nbsp;F. Nasca ,&nbsp;C.D. Cobisi ,&nbsp;M.G.L. Bellia ,&nbsp;C. Burgio ,&nbsp;F. Bosco","doi":"10.1016/j.jcot.2026.103375","DOIUrl":"10.1016/j.jcot.2026.103375","url":null,"abstract":"<div><div>Post-traumatic osteoarthritis (PTOA) following tibial plateau fractures constitutes a demanding indication for total knee arthroplasty (TKA) because of residual deformities, altered joint biomechanics, soft-tissue imbalance, and the potential presence of retained hardware. Conventional TKA in this setting is associated with higher rates of intraoperative complications, suboptimal implant positioning, and increased revision risk. Robotic-assisted (RA) technologies have emerged as potential tools to enhance accuracy, restore alignment, and improve reproducibility in complex knee arthroplasty. The aim of this study is to summarize and critically appraise the current evidence on RA-TKA for PTOA after tibial plateau fractures, highlighting advantages, limitations, and future perspectives. A narrative review was conducted by searching PubMed and Scopus for clinical studies evaluating RA-TKA in the setting of prior tibial plateau fractures. Relevant case series, cohort studies, and comparative analyses were reviewed and synthesized. Preliminary evidence suggests that robotic-assisted TKA may improve the accuracy and reproducibility of component positioning; however, most quantitative accuracy data are derived from primary osteoarthritis cohorts, with limited PTOA-specific evidence currently available. Robotic platforms may also facilitate intraoperative soft-tissue balancing in anatomically distorted knees. However, available literature remains limited to small case series with heterogeneous patient cohorts and short follow-up durations. Functional outcomes and complication rates are inconsistently reported, and robust comparative data are lacking. RA TKA appears to be a promising approach for managing PTOA after tibial plateau fractures. Despite encouraging early results, current evidence is still preliminary. High-quality prospective studies, ideally multicenter with long-term follow-up, are required to substantiate the clinical, functional, and economic benefits of robotics in this challenging population.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"74 ","pages":"Article 103375"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175474","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":"Comparable healing, divergent function in tibia diaphyseal fractures stratified by age","authors":"Alexander M. Lashgari ,&nbsp;Abhishek Ganta ,&nbsp;Kenneth A. Egol ,&nbsp;Sanjit Konda","doi":"10.1016/j.jcot.2026.103376","DOIUrl":"10.1016/j.jcot.2026.103376","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to compare union rates of tibia shaft fractures in two age groups: patients younger than 65 and those 65 or older. Secondary aims included comparing quality measures and functional outcomes.</div></div><div><h3>Methods</h3><div>A retrospective review at a single multi-site urban academic institution was conducted. Inclusion criteria included: age ≥18, isolated OTA 42A to 42C tibia shaft fracture treated with an intramedullary nail, and follow-up ≥6 months. The primary outcome was fracture union, defined as RUST score &gt;7. Functional outcome was measured by the Functional Ambulatory Category (FAC) score (0 = nonfunctional, 5 = independent ambulation). Patients were grouped as young (&lt;65) or elderly (≥65). Univariate and multivariate analyses controlled for confounders.</div></div><div><h3>Results</h3><div>Of 286 patients, 253 were young (mean age 38.9 ± 12.9 years) and 33 elderly (mean age 71.2 ± 6.4 years). Mean follow-up was 13.6 ± 7.9 months. Union rates (94.0% elderly vs. 89.3% young, p = 0.409) and time to union (6.4 vs. 6.1 months, p = 0.647) did not differ. Readmission (18.2% vs. 8.3%, p = 0.069) and complication rates (21.2% vs. 19.0%, p = 0.759) were also similar. After adjusting for baseline FAC, sex, BMI, CCI, fracture type, and injury mechanism, older age was associated with lower FAC scores at three (B = −0.460, 95% CI [-0.826, −0.094], p = 0.014), six (B = −0.371, 95% CI [-0.679, −0.063], p = 0.019), and twelve months (B = −0.317, 95% CI [-0.552, −0.082], p = 0.009).</div></div><div><h3>Conclusions</h3><div>Elderly patients with tibia shaft fractures treated with intramedullary nails achieve similar union rates and healing times as younger patients. However, older age independently predicts reduced ambulatory function post-injury.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"74 ","pages":"Article 103376"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147291785","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 role of genetics and molecular mechanisms in early onset scoliosis","authors":"Shuang Feng ,&nbsp;Yichen Du ,&nbsp;Siu Wai Choi,&nbsp;Kelvin Sin Chi Cheung,&nbsp;Jason Pui Yin Cheung,&nbsp;Zezhou Su","doi":"10.1016/j.jcot.2026.103340","DOIUrl":"10.1016/j.jcot.2026.103340","url":null,"abstract":"<div><div>Early onset scoliosis (EOS), a spinal deformity that occurs before 10 years of age, imposes significant morbidity due to its rapid Cobb angle progression, three-dimensional spinal curvature, and potential respiratory compromise from thoracic cage distortion. This condition, classified into idiopathic, congenital, neuromuscular, and syndromic subtypes, exhibits high phenotypic heterogeneity and multisystem involvement. Current treatments like bracing and surgery focus on modulating curve progression and preserving growth, but the genetic and molecular overview is not clear. This review delineates both the genetic basis and the pathogenic mechanisms of EOS. We summarize 79 genes implicated in EOS subtypes and discuss the underlying pathogenetic mechanisms, including somitogenesis defects, abnormal vertebral development, and neuromuscular disorders. We also highlight emerging therapeutic strategies and discuss future directions. By integrating genetic discoveries with molecular pathophysiology, this review provides a foundation for advancing precision medicine in EOS and highlights critical future research directions in the field.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103340"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078153","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":"Hybrid total hip arthroplasty in patients aged over 75: Patient-reported outcomes and complication rates","authors":"Cesare Meschini ,&nbsp;Mattia Chirico ,&nbsp;Matteo Innocenti ,&nbsp;Giovanni Valentini ,&nbsp;Paolo Salari ,&nbsp;Andrea Baldini","doi":"10.1016/j.jcot.2026.103353","DOIUrl":"10.1016/j.jcot.2026.103353","url":null,"abstract":"<div><h3>Background</h3><div>As the number of total hip arthroplasties (THA) performed in elderly patients continues to rise, the optimal fixation strategy for individuals over 75 years remains debated. Hybrid constructs, combining a cemented femoral stem with an uncemented acetabular component, may offer a balance between immediate mechanical stability and durable biological fixation. This study aimed to evaluate clinical outcomes, complications, implant survivorship, and patient-reported satisfaction following hybrid THA in patients aged &gt;75 years.</div></div><div><h3>Methods</h3><div>A retrospective multicenter study was conducted including patients ≥75 years who underwent primary hybrid THA between 2017 and 2023, with a minimum follow-up of 12 months. All procedures were performed using a mini-posterolateral approach within a standardized fast-track perioperative protocol. Patients were further stratified into two subgroups based on acetabular articulation: Group A, treated with a dual-mobility construct, and Group B, treated with a fixed-bearing liner. Outcomes included the Oxford Hip Score (OHS), patient satisfaction, complications, and Kaplan–Meier survivorship analyses using best- and worst-case scenarios.</div></div><div><h3>Results</h3><div>A total of 642 patients were included (mean age 80.0 ± 4.0 years; 72.6 % female), with a mean follow-up of 39.9 ± 19.4 months. The OHS improved from 22.4 ± 3.3 preoperatively to 42.1 ± 2.8 at final follow-up. Overall satisfaction was high, with 93.5 % of patients reporting a score of 3 or 4 on a 5-point scale. Complication rates were low, including dislocation (1.2 %), periprosthetic fracture (0.5 %), infection (0.2 %), aseptic loosening (0.2 %), and reoperation (1.2 %). Thirty-day readmission was 0.8 %. Overall mortality during follow-up was 6.4 %, with no procedure-related deaths. Implant survivorship was 98.6 % in the best-case and 84.1 % in the worst-case scenario.</div></div><div><h3>Conclusion</h3><div>Hybrid THA in patients over 75 years provides excellent functional recovery, high satisfaction, and low complication rates, supporting its safety and effectiveness in the elderly population. Further long-term prospective studies are warranted.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103353"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078152","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":"Erratum regarding missing statements in previously published articles","authors":"","doi":"10.1016/j.jcot.2026.103343","DOIUrl":"10.1016/j.jcot.2026.103343","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103343"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146189170","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":"Limb occlusion pressure versus standard tourniquet pressure in total: A prospective comparative study","authors":"Narendra Singh Kushwaha ,&nbsp;Ravi Kumar ,&nbsp;Ravindra Mohan ,&nbsp;Sujeet Kumar Chaudhary ,&nbsp;Rashmi Chandra ,&nbsp;Ashish Kumar","doi":"10.1016/j.jcot.2025.103331","DOIUrl":"10.1016/j.jcot.2025.103331","url":null,"abstract":"<div><h3>Background</h3><div>Tourniquet use during total knee arthroplasty (TKA) facilitates a bloodless surgical field but is associated with postoperative complications such as thigh pain, skin changes, and functional delays. Determining optimal tourniquet pressure individualized to each patient is crucial to minimize these adverse effects. Limb occlusion pressure (LOP) provides a physiologic basis for personalized tourniquet pressure settings.</div></div><div><h3>Methods</h3><div>This prospective randomized study enrolled 60 patients undergoing primary TKA, randomized equally into two groups. Group A had tourniquet pressure set using automated LOP measurement plus a safety margin, while Group B used a fixed standard pressure of 300 mmHg. Primary outcomes included tourniquet-site pain (VAS), wound complications (Southampton score), and functional recovery (Oxford Knee Score) at 6 weeks. Secondary measures included intraoperative blood loss and safety events.</div></div><div><h3>Results</h3><div>Group A had significantly lower tourniquet pressures (222.0 ± 28.6 mmHg vs. 300 mmHg, p &lt; 0.001) without increased blood loss (744.2 ± 256.4 ml vs. 709.8 ± 283.7 ml, p = 0.458). Postoperative pain was notably reduced in Group A, with 60 % scoring ≤2 on VAS compared to 20 % in Group B (p = 0.015). Wound healing was superior in Group A (60 % perfect healing vs. 20 %, p = 0.002), with fewer incidences of erythema, blistering, and bruising. Functional outcomes were better in Group A (Oxford Knee Score 35.9 ± 3.0 vs. 32.6 ± 1.7, p &lt; 0.001). No significant neurovascular or thromboembolic complications were reported.</div></div><div><h3>Conclusion</h3><div>LOP-guided individualized tourniquet pressure in TKA significantly reduces postoperative pain and wound complications while maintaining an effective bloodless field and comparable blood loss. Personalized pressure settings enhance early functional recovery and patient comfort, supporting routine LOP use for tourniquet management in orthopedic surgery.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103331"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852498","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":"Erratum regarding missing statements in previously published articles","authors":"","doi":"10.1016/j.jcot.2026.103337","DOIUrl":"10.1016/j.jcot.2026.103337","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103337"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146189168","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":"Impact of preoperative chronic pain diagnosis on unicompartmental knee arthroplasty surgery: Analysis of healthcare utilization and patient reported outcomes","authors":"Shujaa T. Khan,&nbsp;Dimitri Mabarak,&nbsp;Yuxuan Jin,&nbsp;Khaled A. Elmenawi,&nbsp;Nicolas S. Piuzzi","doi":"10.1016/j.jcot.2025.103305","DOIUrl":"10.1016/j.jcot.2025.103305","url":null,"abstract":"<div><h3>Background</h3><div>This study investigates (i) clinically relevant improvements in patient-reported outcome measures (PROMs), (ii) satisfaction rates at one-year post-unicompartmental knee arthroplasty (UKA), and (iii) patterns of healthcare utilization (HCU) in patients with and without preoperative chronic pain.</div></div><div><h3>Methods</h3><div>A total of 1275 patients who underwent primary elective unilateral UKAs at a large tertiary academic center in the United States between 2016 and 2022 were included in the cohort. Electronic medical record (EMR) was used to identify a preoperative diagnosis of chronic pain using ICD coding. The included PROMs were the KOOS Pain, PS, JR. Clinically relevant improvements were evaluated using established minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) threshold achievement.</div></div><div><h3>Results</h3><div>There were 234 (18.4 %) with a chronic pain diagnosis before their UKA. Chronic pain was not associated with failure to reach MCID improvement in any of the KOOS subscales. However, it was associated with failure to reach PASS in KOOS Pain, but not KOOS PS or KOOS JR. Chronic pain was not associated with dissatisfaction at 1-year after UKA (p = 0.112). There was no difference in discharge to home/home healthcare between chronic pain and non-chronic pain patients (p = 0.706). Similarly, there was no statistically significant difference in 90-day readmissions between the two groups (p = 0.38). After adjusting for possible confounding variables, patients with a preoperative chronic pain diagnosis were not associated with a prolonged LOS (p = 0.298).</div></div><div><h3>Conclusion</h3><div>Chronic pain patients reported similar 1-year satisfaction and self-perceived improvement in knee function and pain relief to their non-chronic pain counterparts. Surgeons may use these results to reassure and set optimistic expectations in these patients.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103305"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928359","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}