Acta Oto-Laryngologica最新文献

{"title":"Compensation in neuro-system related to age-related hearing loss.","authors":"Tongxiang Diao, Xin Ma, Xuan Fang, Maoli Duan, Lisheng Yu","doi":"10.1080/00016489.2023.2295400","DOIUrl":"10.1080/00016489.2023.2295400","url":null,"abstract":"<p><strong>Background: </strong>Age-related hearing loss (ARHL) is a major cause of chronic disability among the elderly. Individuals with ARHL not only have trouble hearing sounds, but also with speech perception. As the perception of auditory information is reliant on integration between widespread brain networks to interpret auditory stimuli, both auditory and extra-auditory systems which mainly include visual, motor and attention systems, play an important role in compensating for ARHL.</p><p><strong>Objectives: </strong>To better understand the compensatory mechanism of ARHL and inspire better interventions that may alleviate ARHL.</p><p><strong>Methods: </strong>We mainly focus on the existing information on ARHL-related central compensation. The compensatory effects of hearing aids (HAs) and cochlear implants (CIs) on ARHL were also discussed.</p><p><strong>Results: </strong>Studies have shown that ARHL can induce cochlear hair cell damage or loss and cochlear synaptopathy, which could induce central compensation including compensation of auditory and extra-auditory neural networks. The use of HAs and CIs can improve bottom-up processing by enabling 'better' input to the auditory pathways and then to the cortex by enhancing the diminished auditory signal.</p><p><strong>Conclusions: </strong>The central compensation of ARHL and its possible correlation with HAs and CIs are current hotspots in the field and should be given focus in future research.</p>","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":" ","pages":"30-34"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139545107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of the factors related to air-bone gap in enlarged vestibular aqueduct.","authors":"Rong Wang, Bo-Xiang Zhuang, Weiwei Guo, Jianan Li, Chang Lin, Shiming Yang","doi":"10.1080/00016489.2024.2308014","DOIUrl":"10.1080/00016489.2024.2308014","url":null,"abstract":"<p><strong>Background: </strong>Over half of patients with enlarged vestibular aqueducts (EVA) will have an air-bonr gap (ABG), however, current research on audiology has focused on the influencing factors of air-conducted.</p><p><strong>Objective: </strong>To retrospectively analyse the influencing factors and clinical manifestations of the bone-conduction threshold and ABG in patients with EVA.</p><p><strong>Materials and methods: </strong>We included 286 patients with EVA; among them, 126 had full <i>SLC26A4</i> gene sequence results. We performed a descriptive analysis of the bone-conduction threshold and explored the effect of age. Finally, we analyzed the relationship of ABG and <i>SLC26A4</i> genes with the degree of vestibular aqueduct (VA) enlargement.</p><p><strong>Results: </strong>Among 555 ears, 312 (57.8%) ears had ABG; approximately 94% of the patients' bone-conduction hearing is almost completely lost at frequencies of 2 and 4 kHz. There was no linear correlation between age and bone-conduction threshold (<i>p</i> > 0.05). ABG did not significantly differ according to the degree of VA enlargement and number of <i>SLC26A4</i> allele mutations (<i>p</i> > 0.05).</p><p><strong>Conclusions and significance: </strong>Among patients with EVA, ABG is mainly produced at low frequencies and is not significantly correlated with age, size of the VA opening or <i>SLC26A4</i> genes, which could be attributed to the biomechanical effects.</p>","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":" ","pages":"39-43"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139641406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of iron deficiency with chronic suppurative otitis media in adults.","authors":"Jingwen Cao, Zixuan Yang, Wei Liu, Sijing Chen, Gaoya Qu, Cuiping Zhong","doi":"10.1080/00016489.2024.2310013","DOIUrl":"10.1080/00016489.2024.2310013","url":null,"abstract":"<p><strong>Background: </strong>Chronic suppurative otitis media (CSOM) is a prevalent chronic inflammatory disease globally. Current research suggests a possible association between anaemia and the development of CSOM.</p><p><strong>Objectives: </strong>The objective of this trial was to investigate the relationship between iron metabolism and chronic suppurative otitis media (CSOM) in adults aged 20-60 years.</p><p><strong>Materials and methods: </strong>A consecutive sampling case-control study was used. The study participants were divided into a case group (42 children diagnosed with CSOM) and a control group (42 children with normal ears). Haemoglobin (Hb), Hematocrit (Hct), mean corpuscular volume of erythrocytes (MCV), serum iron level (SI), unsaturated iron-binding capacity (UIBC), total iron-binding capacity (TIBC), transferrin (TF), ferritin (Fer) were tested in all the participants, and the results were compared with the normal ranges of the World Health Organization (WHO). The comparative analysis of cases and controls was performed using the Fisher extract test, independence <i>t</i>-test, or Mann-Whitney <i>U</i> test. <i>p</i>-value <.05 was considered statistically significant for correlation.</p><p><strong>Results: </strong>There were 61 patients with CSOM and 61 controls included in the study. In the case group, 16 out of 61 patients (26.2%) had low ferritin levels and in the control group, 1 out of 61 patients (1.6%) had low ferritin levels (<i>p</i> < .001). In the case group, 6 (9.8%) of 61 patients had IDA, and in the control group, there were no patients with IDA among 61 patients (<i>p</i> = .027). There were significant differences in SI, UIBC, and Fer parameters between the groups.</p><p><strong>Conclusions: </strong>In adult patients, the incidence of iron deficiency was higher in CSOM patients than in controls. Iron deficiency may be considered a potential risk factor for chronic suppurative otitis media, and serum iron parameters should be evaluated in these CSOM patients and further studies should be conducted to better understand the potential link between iron deficiency and CSOM.</p>","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":" ","pages":"19-22"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139690939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Mandarin-speaking prelingual deaf adults benefit from cochlear implant?","authors":"Po-Kai Huang, Pei-Hsuan Ho, Chia-Huei Chu, Pey-Yu Chen, Hung-Ching Lin","doi":"10.1080/00016489.2024.2315299","DOIUrl":"10.1080/00016489.2024.2315299","url":null,"abstract":"<p><strong>Background: </strong>With advances in cochlear implant (CI) technology, prelingual deaf adults may experience improved speech perception and quality of life (QoL). It is still a challenge for Mandarin-speaking CI user with tone recognition due to CI technology focused on intonation language.</p><p><strong>Objectives: </strong>To evaluate the long-term post-CI auditory performance and social-emotional benefits in prelingual deaf Mandarin-speaking adults and the difference between them and post-lingual deaf adults.</p><p><strong>Material and methods: </strong>Fifty-five adult implanted ears were included (forty-six postlingual deaf group; nine prelingual deaf group). Post-CI long-term outcomes were using vowels, consonants, disyllabic words, Mandarin monosyllable words, categories of audiology performance, speech intelligibility rating, subjective social-emotional questionnaires.</p><p><strong>Results: </strong>Post-CI auditory performance and speech intelligibility of prelingual deafness adults was significantly inferior to that of those with postlingual deafness. However, both groups presented improved social-emotional benefits, with no significant difference between both groups.</p><p><strong>Conclusions: </strong>Adult CI recipients who deaf before the age of 4 can experience benefits in social-emotional life functioning, regardless of their limited auditory performance and speech intelligibility. Therefore, prelingual Mandarin-speaking deaf adults, especially those using oral communication, can be considered as relative indications for cochlear implantation.</p><p><strong>Significance: </strong>To clarify and validate the benefits among Mandarin-speaking prelingual deaf adult recipients.</p>","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":" ","pages":"44-51"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139939336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tympanostomy tube placement for intractable Meniere's disease in the elderly.","authors":"Wenting Deng, Yuebo Chen, Hao Xiong, Yongkang Ou","doi":"10.1080/00016489.2024.2312231","DOIUrl":"10.1080/00016489.2024.2312231","url":null,"abstract":"<p><strong>Background: </strong>The treatment of refractory elderly Meniere's disease is a challenge.</p><p><strong>Aim: </strong>To investigate the efficacy of tympanostomy tube placement in elderly patients with Meniere's disease.</p><p><strong>Methods: </strong>31 patients over 60 years old with Meniere's disease who had failed medical treatment and underwent tympanostomy tube placement. Vertigo control, hearing level, tinnitus, and ear fullness were recorded and analyzed preoperatively and postoperatively.</p><p><strong>Results: </strong>All patients completed a 6-month follow-up. At 6 months postoperatively,complete control, substantial control and limited control of vertigo were achieved in 10 (32%), 13 (42%), and 6 (19%) patients respectively. Two patients (6%) reported no substantial improvement. Twelve patients completed a 2-year follow-up. At 2 years postoperatively, complete control, substantial control and limited control of vertigo were achieved in 3 (25%), 5 (42%), and 1 (8%) patients respectively. Three (25%) patients showed no significant improvement in vertigo. The majority of patients reported significant improvement in the functional level scale, the Dizziness Handicap Inventory scores, and ear fullness at 6 months and 2 years postoperatively.</p><p><strong>Conclusions and significance: </strong>Tympanostomy tube placement may reduce vertigo attacks and improved the quality of life in elderly patients with Meniere's disease.</p>","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":" ","pages":"7-13"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139904717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of local dexamethasone on stapedotomy surgery outcomes in patients with otosclerosis.","authors":"Mohammad Mandegari, Mojtaba Meybodian, Mohammadhossein Baradaranfar, Sedighe Vaziribozorg, Mahmood Vakili, Saeedeh Dehghanifirouzabadi","doi":"10.1080/00016489.2024.2304062","DOIUrl":"10.1080/00016489.2024.2304062","url":null,"abstract":"<p><strong>Background: </strong>Some studies have shown a positive effect of systemic corticosteroid on hearing results after stapedotomy, but its side effects can limit its routine administration.</p><p><strong>Aim: </strong>The aim of this study was to investigate the effect of local dexamethasone on the results of stapedotomy surgery.</p><p><strong>Material and methods: </strong>Fifty two patients undergone stapedotomy surgery for otosclerosis involved. In the case group after stapedotomy we fulfilled the middle ear with dexamethasone and then the placement of the prosthesis was done. In the control group after stapedotomy we did not use dexamethasone in the middle ear.</p><p><strong>Results: </strong>Gender, age, nausea, vomiting, postoperative vertigo and nystagmus did not significantly differ between the groups. A significant difference was observed in tinnitus rate between two groups. In the case group ABG decrease was higher and bone conduction thresholds improved at frequencies of 1000, 2000, and 4000 three months after surgery.</p><p><strong>Conclusion: </strong>Since local dexamethasone had a positive effect on the results of stapedotomy surgery, it can be used instead of systemic corticosteroids to reduce the side effects and increasing surgery's success rate.</p><p><strong>Significance: </strong>If local dexamethasone had a positive influence on the results of stapedotomy surgery, it can be used instead of systemic corticosteroids to reduce the side effects and increasing surgery's success rate.</p>","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":" ","pages":"35-38"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139569396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-sodium diet with adequate water intake improved the clinical efficacy in Ménière's disease.","authors":"Xia Yang, Caihong Lin, Qingyun Wu, Lvye Li, Xiaofeng Mei","doi":"10.1080/00016489.2024.2315302","DOIUrl":"10.1080/00016489.2024.2315302","url":null,"abstract":"<p><strong>Background: </strong>Ménière's disease (MD) is a common idiopathic inner ear disorder in otorhinolaryngology characterized by recurrent episodes of vertigo, fluctuating sensorineural hearing loss, tinnitus and ear fullness.</p><p><strong>Objective: </strong>To study the effects of low-sodium diet with adequate water intake on the clinical efficacy in MD.</p><p><strong>Methods: </strong>Fifty patients diagnosed with stage-3 unilateral MD were randomly divided into control group(<i>n</i> = 25) and experimental group(<i>n</i> = 25). The control group was given routine medication therapy, and the experimental group was restricted to an sodium intake of 1500 mg/d and a water intake of 35 ml/kg/d based in addition to the routine medication therapy. The two groups were assessed using pure tone audiometry, electrocochleography, Tinnitus Handicap Inventory (THI), and Dizziness Handicap Inventory (DHI).</p><p><strong>Results: </strong>The pure tone audiometry and electrocochleography showed better improvements after treatment in the experimental group than the control group (<i>p</i> < 0.05). The THI improved values in the experimental group were significantly higher than the control group (<i>p</i> < 0.001). The DHI improved values in the experimental group were significantly higher than the control group (<i>p</i> = 0.004).</p><p><strong>Conclusions and significance: </strong>Low-sodium diet with adequate water intake improved the hearing and alleviated vertigo and tinnitus in MD patients.</p>","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":" ","pages":"14-18"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139904716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Red flags alerting a posterior cranial fossa tumor from audiovestibular perspectives - a review.","authors":"Yi-Ho Young, Yi-Hong Wu","doi":"10.1080/00016489.2024.2316262","DOIUrl":"10.1080/00016489.2024.2316262","url":null,"abstract":"<p><strong>Background: </strong>There is no comprehensive and up-to-date overview of audiovestibular approach to the posterior fossa tumors in the literature.</p><p><strong>Objective: </strong>This paper reviewed the literature relating to tumors at the posterior cranial fossa to find red flags alerting a posterior fossa lesion from audiovestibular perspectives.</p><p><strong>Methods: </strong>This review was developed from articles published in those journals listed on the journal citation reports. Through the PubMed database, Embase, Google Scholar, and Cochrane library, 60 articles were finally obtained based on the PRISMA guidelines for reporting reviews.</p><p><strong>Results: </strong>The presence of one red flag indicates a positive predictive value of 33% for detecting a posterior fossa lesion. Clinical features, namely, 1) mid-frequency sudden sensorineural hearing loss (SNHL), 2) bilateral sudden SNHL, and 3) rebound nystagmus may indicate a posterior fossa lesion, representing one, two, and three red flags, respectively.</p><p><strong>Conclusion: </strong>Those with 1) mid-frequency sudden SNHL, 2) bilateral sudden SNHL, and 3) rebound nystagmus trigger one, two, and three red flags, respectively, alerting clinicians the possibility of a posterior fossa lesion, which warrant MR imaging to exclude life-threatening or treatable conditions.</p><p><strong>Significance: </strong>Patients with posterior fossa tumors may have potential life-threatening outcome.</p>","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":" ","pages":"23-29"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140068068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimal invasive LASER-resection <i>vs</i>. radiotherapy as primary treatment of early glottic cancer. A population-based study with, up to 16 years follow up of survival, rate of laryngectomy and voice function.","authors":"Roland Rydell, Josefine Andreasson, Sara Gustafsson Baldwin, Nathalie Clarhed","doi":"10.1080/00016489.2023.2299674","DOIUrl":"10.1080/00016489.2023.2299674","url":null,"abstract":"<p><strong>Background: </strong>Early glottic cancer can be treated with laser resection or radiotherapy. In an earlier study, we found that voice function after laser resection was inferior to that after radiotherapy.</p><p><strong>Objectives: </strong>This study was designed to determine if reduced margins at laser resection improved voice function without impairing oncologic results.</p><p><strong>Method: </strong>A total of 268 patients with previously untreated T1-T2 glottic carcinoma were studied. They were primarily treated with either radiotherapy (<i>n</i> = 119) or laser resection (<i>n</i> = 149). Survival, need for additional treatment (radiotherapy and/or total layngectomi) and voice function was compared.</p><p><strong>Result: </strong>Median follow up time was 7 years with range 0.5-16.6. There was no difference in the overall survival (<i>p</i> = .065) or disease-specific survival. (<i>p</i> = .126). After radiotherapy 32/119 patients and after laser resection 57/149 patients had recurrence. Total rate of laryngectomy was 24% in the radiotherapy group, and 8% in the laser resection group (<i>p</i> = .001). Voice analysis (T1A) showed more roughness in the radiotherapy group, otherwise no difference.</p><p><strong>Conclusions: </strong>By reducing the surgical margins, we have achieved a better voice function (T1A) but more patients have needed repeated laser excisions and some have also needed supplementary radiotherapy. The risk of laryngectomy and survival were apparently not affected.</p>","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":" ","pages":"58-64"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139641405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mucosal melanoma of the head and neck: a retrospective analysis of 34 cases in Japan.","authors":"Keiichi Tamura, Yohei Kumabe, Yo Kishimoto, Morimasa Kitamura, Masanobu Mizuta, Hisanobu Tamaki, Keigo Honda, Koichiro Yamada, Shinzo Tanaka, Tsuyoshi Kojima, Ryo Asato, Koji Ushiro, Shogo Shinohara, Shinji Takebayashi, Toshiki Maetani, Kazuyuki Ichimaru, Yoshiharu Kitani, Koichi Omori","doi":"10.1080/00016489.2024.2314590","DOIUrl":"10.1080/00016489.2024.2314590","url":null,"abstract":"<p><strong>Purpose: </strong>Mucosal melanoma of the head and neck (MMHN) is a rare condition. This study aimed to investigate oncological outcomes of surgical intervention in patients with MMHN.</p><p><strong>Materials and methods: </strong>The study included 34 patients with MMHN who underwent surgical resection as initial treatment at 10 institutions in Japan between July 2005 and June 2015. Results: The 5-year overall survival (OS), local control rate (LCR), disease-free survival (DFS), and disease-specific survival (DSS) rates were 48.7%, 53.4%, 32.4%, and 55.1%, respectively. Based on multivariate analysis, no independent prognostic factors for the 5-year OS and DSS were found. Based on univariate analysis, the 5-year LCR was worse in patients with lesions in the nasal cavity and paranasal sinuses than in the oral cavity and pharynx. However, no differences in oncological outcomes were identified in relation to primary sites, and postoperative radiotherapy (PORT) and adjuvant systemic therapy did not contribute to improvements in the 5-year OS.</p><p><strong>Conclusions: </strong>No independent prognostic factors for the 5-year OS or DSS were identified. Regional or distant recurrences are often identified, regardless of local control with surgical resection. Difficult control of MMHN with conventional therapeutic strategies, such as surgical intervention, PORT, and systemic therapy, has been suggested.</p>","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":" ","pages":"82-89"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139740114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}