Claes Mercke, Signe Friesland, Anders Berglund, Gun Wickart Johansson, Gregori Margolin, Michael Gubanski, Einar Björgvinsson, Josef Nilsson
{"title":"\"High-risk\" tumors of the lip treated with external beam radiotherapy and high-dose-rate brachytherapy: Long-term outcome.","authors":"Claes Mercke, Signe Friesland, Anders Berglund, Gun Wickart Johansson, Gregori Margolin, Michael Gubanski, Einar Björgvinsson, Josef Nilsson","doi":"10.1002/hed.27936","DOIUrl":"https://doi.org/10.1002/hed.27936","url":null,"abstract":"<p><strong>Background: </strong>Radiotherapy is a well-established treatment for lip cancer, with external radiotherapy (EBRT) or brachytherapy (BT).</p><p><strong>Methods: </strong>This study evaluated outcome, tumor control, and aesthetics, for 101 patients with carcinoma of the lip, not suitable for surgery, treated with combined EBRT and BT.</p><p><strong>Results: </strong>Squamous cell carcinoma was seen in 78 patients, basal cell carcinoma in 15, and other histologies in 8 patients. Tumors were advanced: 73% in category T2-T4. Local control at 3 and 5 years was 89%. Local failure appeared in 4/56 patients (7%) with primary RT compared to 7/45 (16%) in those with prior surgery, regional recurrence in 5 patients. Toxicity was mild. Cosmetic outcome, 87 patients evaluated, was bad for 9/40 patients with upfront surgery compared to 1/47 for primary RT patients (p = 0.003). Seven patients died from lip cancer (7%), three with originally N+ disease (43%).</p><p><strong>Conclusions: </strong>Combined EBRT and BT could be considered for lip tumors not candidates for surgery.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Linus L Kienle, Leon R Schild, Felix Boehm, Viola D Hahn, Jens Greve, Adrian von Witzleben, Thomas K Hoffmann, Patrick J Schuler
{"title":"Bending the rules: A novel approach to laryngeal surgery in a body donor study.","authors":"Linus L Kienle, Leon R Schild, Felix Boehm, Viola D Hahn, Jens Greve, Adrian von Witzleben, Thomas K Hoffmann, Patrick J Schuler","doi":"10.1002/hed.27939","DOIUrl":"https://doi.org/10.1002/hed.27939","url":null,"abstract":"<p><strong>Background: </strong>Transoral laser microsurgery, the standard surgical approach for early-stage laryngeal cancer, necessitates an unobstructed line of sight to the operating field. However, achieving adequate laryngeal exposure can be challenging, potentially compromising treatment outcomes.</p><p><strong>Methods: </strong>We developed a 3D-printed curved laryngoscope (sMAC), designed to match the upper airway anatomy. In a user study (n = 15) with a human body donor we compared the sMAC system to conventional microlaryngoscopy regarding laryngeal exposure and accessibility in a difficult exposure scenario.</p><p><strong>Results: </strong>All 15 participants achieved complete glottic exposure and successfully manipulated laryngeal landmarks using the sMAC system. Only four participants achieved partial exposure using microlaryngoscopy. Positioning of the sMAC system was significantly faster (p = 0.023). A vocal cord resection was conducted successfully (n = 2) using the sMAC system.</p><p><strong>Conclusion: </strong>The sMAC system effectively addresses challenges associated with transoral laryngeal surgery. Ongoing development aims to overcome current limitations of the system and prepare first clinical trials.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marcelo Elias Schempf Cattan, Talita de Carvalho Kimura, Luccas Lavareze, Erika Said Abu Egal, Albina Altemani, Fernanda Viviane Mariano
{"title":"Head and neck sarcomas: Thirty years of experience in a tertiary referral center in Brazil.","authors":"Marcelo Elias Schempf Cattan, Talita de Carvalho Kimura, Luccas Lavareze, Erika Said Abu Egal, Albina Altemani, Fernanda Viviane Mariano","doi":"10.1002/hed.27933","DOIUrl":"https://doi.org/10.1002/hed.27933","url":null,"abstract":"<p><strong>Purpose: </strong>This study analyzed the demographics, clinicopathological, treatment, and survival characteristics of head and neck sarcomas (HNS) diagnosed in a tertiary reference center in Brazil.</p><p><strong>Materials and methods: </strong>HNS cases were retrospectively retrieved from the Department of Pathological Anatomy of the School of Medical Sciences of the State University of Campinas. The medical records were examined to extract demographic, clinicopathological, and follow-up information. The Pearson chi-square test, Kaplan-Meier curve, and Cox proportional hazards regression model were employed to identify survival and potential prognostic factors.</p><p><strong>Results: </strong>A total of 47 patients were included in the study. The majority were men (61.7%) with a mean age of 38.9 years. The nasal cavity (34.0%) was the most common anatomical site. The lesions are usually presented as volume increases (78.7%). The most common histological subtypes were chondrosarcoma, osteosarcoma, and alveolar rhabdomyosarcoma. Surgical excision alone was the most common treatment modality. Local recurrence was observed in 10 cases, and metastases in 3 cases. During a mean follow-up period of 71.9 months, from diagnosis to the last follow-up, 31 patients (65.9%) were alive without the disease. A total of 10 patients (21.3%) died of the HNS for a mean follow-up period of 14.3 months. The time to presentation of more than 6 months (p = 0.0309) and the presence of metastases (p = 0.0315) were identified as prognostic factors for survival, while male sex was found to be an independent prognostic factor for recurrence.</p><p><strong>Conclusion: </strong>In conclusion, the results of this study indicate that the occurrence of a shorter lesion time to presentation and the presence of metastases were associated with a reduction in survival rates in patients with HNS.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shu Yi, Xiaoming Lyu, Wei Wang, Mingwei Huang, Shuming Liu, Jie Zhang
{"title":"Axial split step osteotomy of free iliac crest flaps for mandible reconstruction: Preliminary results.","authors":"Shu Yi, Xiaoming Lyu, Wei Wang, Mingwei Huang, Shuming Liu, Jie Zhang","doi":"10.1002/hed.27941","DOIUrl":"https://doi.org/10.1002/hed.27941","url":null,"abstract":"<p><strong>Background: </strong>Vascularized bone grafting (VBG) is preferred for mandibular reconstruction post-tumor ablation. Although various bone-free flaps are used, their application is compromised by limitations including insufficient bone volume and poor shape. Here, we report mandibular reconstruction using axial split-step osteotomy with an iliac crest-free flap.</p><p><strong>Methods: </strong>Over December 2018-November 2020, 12 patients underwent mandibular reconstruction via axial split osteotomy using a free iliac-crest flap.</p><p><strong>Results: </strong>The preoperative iliac-crest length was 5.7-9.5 mm (median, 7.5 cm); the mean post-axial split-osteotomy iliac-crest length increased to 9.59 mm (range, 6.34-15.15 mm). All patients presented with initial healing 2 weeks postoperation; good bone healing was achieved in all grafted flaps by the third month of follow-up.</p><p><strong>Conclusions: </strong>We propose a new axial split-step osteotomy technique using free iliac-crest flaps for mandibular reconstruction. We demonstrated this novel technique's reliability for safe and effective bone lengthening and establishing a reliable occlusal relationship.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evaluating the reduction of elective radiotherapy fields for de novo metastatic nasopharyngeal carcinoma in the immunotherapy era.","authors":"Ting Jin, Pei-Jing Li, Qi-Feng Jin, Yong-Hong Hua, Xiao-Zhong Chen","doi":"10.1002/hed.27931","DOIUrl":"https://doi.org/10.1002/hed.27931","url":null,"abstract":"<p><strong>Background: </strong>This study evaluates the outcomes of omitting the high- and low-risk clinical tumor volume (CTV1 and CTV2) radiation in de novo metastatic nasopharyngeal carcinoma (dnm-NPC) patients in the immunotherapy era.</p><p><strong>Methods: </strong>We retrospectively analyzed 45 consecutive dnm-NPC patients receiving chemotherapy and immunotherapy combined with radiotherapy (CIR) from October 9, 2018 to June 1, 2022. Irradiation was only delivered to the primary tumor and retropharyngeal nodes (GTVnx+rn) and gross cervical lymph nodes (GTVnd).</p><p><strong>Results: </strong>The median follow-up was 45 (range, 15-67) months. There was no recurrence in the omitted elective regions. The 36-month LRRFS, PFS, and OS were 95.4%, 44.6%, and 90.8%, respectively. The main grade 3/4 hematologic toxicities were neutropenia (42.2%), anemia (20.0%), and thrombocytopenia (13.3%). The incidence of acute grade 3/4 dermatitis, mucositis, and xerostomia were 4.4%, 8.9%, and 4.4%, respectively.</p><p><strong>Conclusions: </strong>Omitting CTV1 and CTV2 was well-tolerated and provided favorable clinical outcomes in the era of immunotherapy.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David M Bruss, David J Fei-Zhang, Helena Kim, Daniel C Chelius, Anthony M Sheyn, John P Maddalozzo, Jeffrey C Rastatter, Jill N D'Souza
{"title":"The impact of digital inequities on salivary gland cancer disparities in the United States.","authors":"David M Bruss, David J Fei-Zhang, Helena Kim, Daniel C Chelius, Anthony M Sheyn, John P Maddalozzo, Jeffrey C Rastatter, Jill N D'Souza","doi":"10.1002/hed.27930","DOIUrl":"https://doi.org/10.1002/hed.27930","url":null,"abstract":"<p><strong>Introduction: </strong>Technology and internet access have become increasingly integrated into healthcare as the primary platform for health-related information and provider-patient communication. Disparities in access to digital resources exist in the United States and have been shown to impact health outcomes in various head and neck malignancies. Our objective is to evaluate the associations of digital inequity on health outcomes in patients with salivary gland cancer (SGC).</p><p><strong>Methods: </strong>The Digital Inequity Index (DII) was developed using 17 census-tract level variables obtained from the American Community Survey and Federal Communications Commission. Variables were categorized as digital infrastructure or sociodemographic (e.g., non-digital) and scored based on relative rankings across all US counties. Scores were assigned to patients from the Surveillance-Epidemiology-End Results (SEER) database diagnosed with SGC between 2013 and 2017 based on county-of-residence. Regressions were performed between DII score and outcomes of surveillance time, survival time, tumor stage at time of diagnosis, and treatment modality.</p><p><strong>Results: </strong>Among 9306 SGC-patients, increased digital inequity was associated with advanced-staging at presentation (OR: 1.04, 95% CI: 1.01-1.07, p = 0.033), increased odds of chemotherapy receipt (OR: 1.05, CI: 1.01-1.10, p = 0.010), and decreased odds of surgical intervention (OR: 0.94, 95% CI: 0.91-0.98, p = 0.003) after accounting for traditional sociodemographic factors. Increased digital inequity was also associated with decreased surveillance time and survival periods.</p><p><strong>Conclusions: </strong>Digital inequity significantly and independently associates with negative health and treatment outcomes in SGC patients, highlighting the importance of directed efforts to address these seldom-investigated drivers of health disparities.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comparative effectiveness and cost-effectiveness of endoscopic nasopharyngectomy versus intensity-modulated radiotherapy in the treatment of recurrent nasopharyngeal carcinoma: A microsimulation analysis.","authors":"Mingjun Rui, Yingcheng Wang","doi":"10.1002/hed.27942","DOIUrl":"https://doi.org/10.1002/hed.27942","url":null,"abstract":"<p><strong>Background: </strong>Nasopharyngeal carcinoma (NPC) is a significant health concern in southern China, like Guangdong and Hong Kong. This study aims to predict the effectiveness and cost-effectiveness of two prevalent NPC treatments, intensity-modulated radiotherapy (IMRT) and endoscopic nasopharyngectomy (ENPG).</p><p><strong>Methods: </strong>A microsimulation model was developed to project the long-term outcomes of IMRT and ENPG, simulating 5000 patients with hypothetical locally recurrent NPC for each treatment option. The tumors of patients confined to the nasopharyngeal cavity, the post-naris or nasal septum, the superficial parapharyngeal space, or the base wall of the sphenoid sinus. Analyses were performed from the healthcare system perspectives of Mainland China and the healthcare provider perspective of Hong Kong, with input parameters sourced from the existing literature and databases. The robustness of findings was evaluated through one-way and probabilistic sensitivity analyses.</p><p><strong>Results: </strong>For DFS, ENPG showed a 29% reduction in risk with an HR of 0.71 (95% CI: 0.64-0.77) compared to IMRT. ENPG demonstrated a significant survival benefit in OS with an HR of 0.59 (95% CI: 0.54-0.65), equating to a 41% reduction in mortality risk. In Hong Kong, IMRT and ENPG yielded QALY gains of 4.59 and 6.29, respectively, with ENPG exhibiting an incremental cost-effectiveness ratio (ICUR) of USD 13 057 per QALY. For Mainland China, ENPG denominated the IMRT and the ICUR was USD -1450 QALY. Probabilistic sensitivity analysis showed a 100% probability of ENPG being cost-effective at the willingness-to-pay thresholds of USD 130 490 per QALY in Hong Kong and USD 12 741 per QALY in Mainland China.</p><p><strong>Conclusion: </strong>The analysis confirms that ENPG is more effective and cost-effective than IMRT for treating recurrent NPC in both Hong Kong and Mainland China.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Linmei Zhang, Enzhao Zhu, Shaokang Cao, Zisheng Ai, Jiansheng Su
{"title":"Integrating lymph node ratio into personalized radiotherapy for oral cavity squamous cell carcinoma.","authors":"Linmei Zhang, Enzhao Zhu, Shaokang Cao, Zisheng Ai, Jiansheng Su","doi":"10.1002/hed.27938","DOIUrl":"https://doi.org/10.1002/hed.27938","url":null,"abstract":"<p><strong>Purpose: </strong>The use of postoperative radiotherapy (PORT) in patients with oral squamous cell carcinoma (OCSCC) lacks clear boundaries due to the non-negligible toxicity accompanying its remarkable cancer-killing effect. This study aims at validating the ability of deep learning models to develop individualized PORT recommendations for patients with OCSCC and quantifying the impact of patient characteristics on treatment selection.</p><p><strong>Methods: </strong>Participants were categorized into two groups based on alignment between model-recommended and actual treatment regimens, with their overall survival compared. Inverse probability treatment weighting was used to reduce bias, and a mixed-effects multivariate linear regression illustrated how baseline characteristics influenced PORT selection.</p><p><strong>Results: </strong>4990 patients with OCSCC met the inclusion criteria. Deep Survival regression with Mixture Effects (DSME) demonstrated the best performance among all the models and National Comprehensive Cancer Network guidelines. The efficacy of PORT is enhanced as the lymph node ratio (LNR) increases. Similar enhancements in efficacy are observed in patients with advanced age, large tumors, multiple positive lymph nodes, tongue involvement, and stage IVA. Early-stage (stage 0-II) OCSCC may safely omit PORT.</p><p><strong>Conclusions: </strong>This is the first study to incorporate LNR as a tumor character to make personalized recommendations for patients. DSME can effectively identify potential beneficiaries of PORT and provide quantifiable survival benefits.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Filippo Marchi MD, Valentina Campagnari MD, Marta Filauro MD, Andrea Iandelli MD, Cesare Piazza MD, Giorgio Peretti MD
{"title":"Improving oropharyngeal cancer diagnosis and management: A call for accurate p16/HPV DNA testing in Southern Europe","authors":"Filippo Marchi MD, Valentina Campagnari MD, Marta Filauro MD, Andrea Iandelli MD, Cesare Piazza MD, Giorgio Peretti MD","doi":"10.1002/hed.27934","DOIUrl":"10.1002/hed.27934","url":null,"abstract":"","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":"46 12","pages":"3146-3147"},"PeriodicalIF":2.3,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Correction to “Circulating tumor HPV DNA in the management of HPV+ oropharyngeal cancer and its correlation with MRI”","authors":"","doi":"10.1002/hed.27929","DOIUrl":"10.1002/hed.27929","url":null,"abstract":"<p>Campo F, Paolini F, Manciocco V, et al. Circulating tumor HPV DNA in the management of HPV+ oropharyngeal cancer and its correlation with MRI. <i>Head Neck</i>. 2024;46(9):2206–2213. doi: 10.1002/hed.27866. Epub 2024 Jul 9. PMID: 38979763.</p><p>In paragraph 3.2, ctHPVDNA at diagnosis: “117 consecutive patients were prospectively enrolled in the study. In the study, 69 patients were p16+/HPV16+, 3 were p16/HPV33+, 6 were p16/HPV35+, 12 were p16+/HPV, 24 were p16 /HPV, and 1 was p16 /HPV16+.” This should have read:</p><p>“117 consecutive patients were prospectively enrolled in the study. In the study, 71 patients were p16+/HPV16+, 3 were p16/HPV33+, 6 were p16/HPV35+, 12 were p16+/HPV, 24 were p16 /HPV, and 1 was p16 /HPV16+.”</p><p>In paragraph 3.3, Longitudinal monitoring of ctHPVDNA: “To test for correlation of treatment response with ctHPVDNA, we collected sequential post-treatment blood samples in 60 of the 82 patients.” This should have read:</p><p>“To test for correlation of treatment response with ctHPVDNA, we collected sequential post-treatment blood samples in 60 of the 83 patients.”</p><p>We apologize for these errors.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":"46 11","pages":"2912"},"PeriodicalIF":2.3,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hed.27929","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}