Journal of Brachial Plexus and Peripheral Nerve Injury最新文献

{"title":"Use of a Pedicled Vascularized Ulnar Nerve as a Long Graft for Complete Brachial Plexus Palsy in Adults to Restore Elbow Flexion: Should this Practice Continue?","authors":"Camille Echalier, Jean Noël Goubier","doi":"10.1055/a-2694-8871","DOIUrl":"10.1055/a-2694-8871","url":null,"abstract":"<p><p>Restoring elbow flexion is a priority in adults with complete brachial plexus palsy. If the nerve root is not avulsed, a graft can be placed between the existing root and the musculocutaneous nerve. The aim of this study was to evaluate the outcomes of using vascularized ulnar nerve grafts in this context. Our case series consisted of 17 male and 3 female patients (mean age of 31 years) presenting complete brachial plexus palsy after a motorcycle accident. A graft at the C5 or C6 root on the musculocutaneous nerve was done in all patients using a pedicled vascularized ulnar nerve to restore elbow flexion at a mean of 5 months after the accident. At a mean follow-up of more than 3 years, elbow flexion was graded as M4 in six patients and between M0 and M2 in the other 14 patients on the Medical Research Council scale. None of the patients had M3 strength. While the results of long grafts using a vascularized ulnar nerve are disappointing in this case series, they are consistent with previous publications. Encouraging results have only been reported with short grafts (<10 cm), which can rarely be used with supraclavicular lesions. For this reason, we currently prefer using a sural nerve graft or nerve transfer, when possible, to restore elbow flexion in adult patients with brachial plexus injuries.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"20 1","pages":"e66-e70"},"PeriodicalIF":1.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fracture Patterns and Peripheral Brachial Plexus Injury in Humerus Fractures: A Retrospective Study.","authors":"Mohammed Musaed Almalki, Bander S Alrashedan, Ahmed Shaya Alragea, Adel Faiz Alshihri, Hani S Serhan, Husam Fahmi AlFashtaki","doi":"10.1055/a-2596-1347","DOIUrl":"10.1055/a-2596-1347","url":null,"abstract":"<p><strong>Background: </strong>Peripheral brachial plexus injuries, particularly Radial nerve palsy (RNP), are a common complication of humeral shaft fractures. Despite previous research, the specific fracture patterns associated with RNP remain unclear.</p><p><strong>Objectives: </strong>This study aims to assess the frequency and patterns of humeral shaft fractures, determine the incidence of peripheral brachial plexus injuries such as radial and ulnar nerve palsies, and investigate the association between specific fracture patterns and these nerve injuries. We also explored other factors influencing RNP development and identified potential risk factors or predictors.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed 144 patients with humeral shaft fractures at King Saud Medical City from 2015 to 2022. Patient data, such as age, gender, and neurovascular status, were extracted and analyzed using SPSS. RNP was diagnosed clinically. Statistical analyses included chi-square and student <i>t</i> -tests, with a <i>p</i> -value of <0.05 for significance.</p><p><strong>Results: </strong>This study found a 37.5% incidence of RNP in humeral shaft fractures. Significant differences were observed in age ( <i>p</i>  = 0.032) and mechanism of injury ( <i>p</i>  < 0.0001), with most fractures due to road traffic accidents (72.22%) and closed (93.75%). Common fracture patterns were AO 12A (37.5%) and AO 12B (39.58%), with a higher prevalence of comminuted fractures (71 cases). Significant differences in fracture patterns ( <i>p</i>  < 0.0001) and anteromedial comminution ( <i>p</i>  = 0.002) were noted between patients with and without RNP. Interestingly, four cases of concomitant ulnar nerve palsy were observed in patients with radial nerve palsy. However, no significant differences were found in gender ( <i>p</i>  = 0.343), open fractures ( <i>p</i>  = 0.214), or associated fractures ( <i>p</i>  = 0.106).</p><p><strong>Conclusion: </strong>This study suggests that the severity of trauma, rather than specific fracture patterns, is a more significant factor in RNP development in humeral shaft fractures. Further research is needed to understand the underlying biomechanics.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"20 1","pages":"e53-e58"},"PeriodicalIF":1.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ulnar Nerve Granuloma Presenting as a Peripheral Nerve Sheath Tumor: A Case Report and Literature Review.","authors":"John K Yue, Jia-Shu Chen, Mahmoud M Elguindy, Vivian Tang, Ryan Tripathy, Allison R Bond, Alexander A Aabedi, Vinil N Shah, Arie Perry, Andrew W Bollen, Dong Heun Lee, Line G Jacques","doi":"10.1055/a-2667-7286","DOIUrl":"10.1055/a-2667-7286","url":null,"abstract":"<p><p>Peripheral nerve masses have a wide differential diagnosis; however, there is no established diagnostic framework for evaluating non-neoplastic etiologies, such as inflammatory or infectious lesions. Here, we present a rare case of an ulnar nerve granuloma that initially mimicked a peripheral nerve sheath tumor (PNST) on imaging and clinical presentation to elucidate the relevant medical history, imaging, and histology that aid in distinguishing inflammatory, infectious, and neoplastic peripheral nerve lesions. An 85-year-old man with melanoma and multiple prior right elbow surgeries presented with right-hand weakness and a rapidly enlarging gadolinium-enhancing ulnar nerve mass suggestive of a PNST that warranted surgical resection. Surgical histology showed a necrotizing granulomatous lesion that then became most concerning for a parasitic infection. However, broad serum and histologic testing by the Centers for Disease Control and Prevention were all ultimately negative. The final diagnosis was an inflammatory reaction to a retained foreign body from his prior elbow surgeries. In summary, surgery and comprehensive histologic workup are required for diagnosing granulomatous peripheral nerve lesions that mimic PNSTs on imaging and infection on histology.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"20 1","pages":"e59-e65"},"PeriodicalIF":1.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple Electrophysiological Evaluation of Carpal Tunnel Syndrome.","authors":"XueYan Wu, Qiuju Su, Ping Ding, Jie Ji, JiaYi Zhu","doi":"10.1055/a-2644-7508","DOIUrl":"10.1055/a-2644-7508","url":null,"abstract":"<p><strong>Introduction: </strong>To investigate a high-sensitivity electrodiagnostic (EDX) combination for diagnosing mild carpal tunnel syndrome (CTS).</p><p><strong>Methods: </strong>A total of 68 healthy controls (HCs, 136 hands) and 91 adult patients (CTSs, 162 hands) clinically diagnosed with CTS were enrolled. All patients accepted EDXs, including the sensory ganglia segment method of the median and ulnar nerves, and motor nerve conduction of the median and ulnar nerves. We examined the electrophysiological results and compared the sensitivity and specificity of various sensory nerve detection methods for the median nerve between the two groups.</p><p><strong>Results: </strong>The electrophysiological results of the CTSs were significantly different from those of HCs. All EDX techniques selected showed high specificity (>96.3%), positive predictive value (>95.2%), and large area under the curve (0.922 as the smallest) for the diagnosis of CTSs. A comparison of the median distal sensory latencies with the ulnar distal sensory latencies in fingers 2 and 4 showed a high sensitivity of 98.1%. Comparison of the nerve conduction study between the median and ulnar nerves in the same hand is the most reliable EDX technique for diagnosing very mild CTS because of its high sensitivity and specificity.</p><p><strong>Conclusion: </strong>If clinical CTS patients exhibit normal median motor distal latency or sensory nerve conduction velocity across the wrist, a comparison of median and ulnar nerve conduction through the wrist, including M-U and M-U ringdiff, is recommended.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"20 1","pages":"e47-e52"},"PeriodicalIF":1.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coracohumeral Ligament Sectioning in Teres Major versus Latissimus Dorsi Tendon Transfer in Brachial Plexus Birth Palsy.","authors":"Javier Gutierrez-Pereira, Antonio Garcia-Lopez","doi":"10.1055/a-2618-3151","DOIUrl":"10.1055/a-2618-3151","url":null,"abstract":"<p><strong>Background: </strong>The latissimus dorsi tendon transfer (LDTT) to the supraspinatus tendon is a common procedure for restoring shoulder abduction and external rotation in upper root brachial plexus lesions. However, its association with scapular retraction often limits shoulder abduction.</p><p><strong>Methods: </strong>This retrospective study compared the functional outcomes of teres major tendon transfer (TMTT) combined with anterior coracohumeral ligament release (CHLR) versus LDTT. Patients who underwent surgery at our center between January 2012 and December 2022 were included, with a mean follow-up of 38 months. Outcomes were assessed using a range of motion and the Mallet scale.</p><p><strong>Results: </strong>A total of 40 patients were included, with 20 undergoing TMTT with CHLR and 20 undergoing LDTT. The overall mean age was 3.9 years (range: 2.7-4.8), with mean ages of 3.4 years (range: 2.2-5.2) in the LDTT group and 4.1 years (range: 2.8-5.2) in the TMTT with the CHLR group. The TMTT with CHLR group achieved mean gains of +77 degrees in active abduction, +44 degrees in active external rotation, and +46 degrees in passive external rotation. In comparison, the LDTT group demonstrated gains of +46, +27, and +24 degrees, respectively, for the same parameters.</p><p><strong>Conclusion: </strong>TMTT combined with anterior CHLR significantly improves shoulder abduction and external rotation in patients with Brachial plexus birth injury, particularly those with internal rotation contractures. This technique offers superior functional outcomes compared to LDTT, suggesting a more effective therapeutic alternative.</p><p><strong>Level of evidence: </strong>IV, retrospective comparative study.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"20 1","pages":"e41-e46"},"PeriodicalIF":1.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12178672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brachial Plexus Anatomy of Sprague Dawley Rat Compared to Human.","authors":"Alison N Jacobs, Luke J Bolstad, Natalie Martinson, Ethan Mickelson, Matthew R Ceelen, Owen R Lefebvre, Roy Ram Klein, Daniel J Hellenbrand, Amgad S Hanna","doi":"10.1055/a-2591-2757","DOIUrl":"10.1055/a-2591-2757","url":null,"abstract":"<p><p>Brachial plexus injury (BPI) occurs when the brachial plexus (BP) is compressed, stretched, or avulsed. A mild BPI results in acute arm pain, tingling, or numbness, while more severe injuries can lead to permanent muscle weakness or loss of function of the extremity if left untreated. Many BPI treatments developed in small animal models fail to translate effectively to human clinical trials. Furthermore, there is a lack of comparative studies exploring the anatomical differences between BPs in different species. The objective of this study is to compare the BP anatomy between humans and Sprague-Dawley (SD) rats to determine if the SD rat is a suitable model for studying BPI mechanisms and treatments. Four human BPs were compared to five SD rat BPs. Gross anatomical analysis revealed mild similarities in the branching patterns of SD rat and human BP. Histological results indicated that SD rats had significantly smaller musculocutaneous ( <i>p</i>  = 0.0095), median ( <i>p</i>  < 0.0001), and ulnar ( <i>p</i>  < 0.0001) nerves compared to humans. Additionally, SD rats had significantly fewer axons than humans in the musculocutaneous ( <i>p</i>  = 0.0190), median ( <i>p</i>  < 0.0001), and ulnar nerves ( <i>p</i>  < 0.0001). Due to the anatomical and histological differences between the two species, therapeutic interventions for BPIs developed in rats should be further tested in a larger animal model, such as the Wisconsin Miniature Swine, before progressing to human clinical trials.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"20 1","pages":"e31-e40"},"PeriodicalIF":1.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Assessment of Nerve Traction Injury in Obstetric Brachial Plexus Palsy.","authors":"J Bahm, B Schäfer, K Nolte, J Weis, J P Beier","doi":"10.1055/a-2572-2601","DOIUrl":"https://doi.org/10.1055/a-2572-2601","url":null,"abstract":"<p><p>We present an easy classification for nerve lesions observed in reconstructive surgery for obstetric brachial plexus palsy, performed through a supraclavicular approach and systematic exposure of nerve roots and trunks. A description of signs related to nerve traction injury (scarring, fascicular rupture, and dislocated ganglions) is combined with a grading system of microscopic tissue changes occurring in slices from traumatized nerve endings (fascicular structure, changes in perineurium and endoneurium). Both tools are proposed for any surgical brachial plexus exploration and later interaction with other professionals (pediatricians, physiotherapists, or obstetricians).</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"20 1","pages":"e27-e30"},"PeriodicalIF":1.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Happy Birthday, Dear Journal!","authors":"Jörg Bahm","doi":"10.1055/a-2519-5062","DOIUrl":"10.1055/a-2519-5062","url":null,"abstract":"","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"20 1","pages":"e26"},"PeriodicalIF":1.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cortical Neurotransmitters Measured by Magnetic Resonance Spectroscopy Change Following Traumatic Brachial Plexus Injury.","authors":"Ryckie G Wade, Gráinne Bourke, Alexandra M Olaru, Stephen R Williams, David Shelley, Sven Plein, Robert D Bains, James D Bedford, Lucy E Homer Newton, Chye Yew Ng, Laura Parkes, Caroline Lea-Carnall","doi":"10.1055/a-2505-5657","DOIUrl":"https://doi.org/10.1055/a-2505-5657","url":null,"abstract":"<p><p><b>Introduction</b>  GABA (γ-aminobutyric acid) is the major inhibitory neurotransmitter in the brain. In response to injury within the central nervous system, GABA promotes cortical plasticity and represents a potential pharmacological target to improve functional recovery. However, it is unclear how GABA changes in the brain after traumatic brachial plexus injuries (tBPIs) which represents the rationale for this pilot study. <b>Methods</b>  We serially scanned seven males (mean age 42 years [SD 19] without head injury) up to 19 months after tBPIs. T1-weighted images (1-mm isotropic resolution) and J-edited spectra (MEscher-GArwood Point RESolved Spectroscopy [MEGA-PRESS], TE 68 ms, TR 2,000 ms, 2 cm isotropic voxels) were acquired using a MAGNETOM Prisma 3T (Siemens Healthcare, Erlangen, Germany). Data were analyzed in jMRUI blind to clinical information to quantify GABA, creatine plus phosphocreatine (Cr), and N-acetylaspartate (NAA) concentrations. Additionally, gray matter and white matter proportions were assessed using SPECTRIM software. Interhemispheric means were compared using linear methods. Confidence intervals (CIs) were generated to the 95% level. <b>Results</b>  Within weeks of injury, the hemisphere representing the injured upper limb had a significantly lower GABA:NAA ratio (mean difference 0.23 [CI 0.06-0.40]) and GABA:Cr ratio (mean difference 0.75 [CI 0.24-1.25]) than the uninjured side. There were no interhemispheric differences in NAA:Cr. By 12 months post-injury, interhemispheric differences in metabolite concentrations equalized. There was no difference in the proportion of gray matter, white matter, or cerebrospinal fluid between the injured and uninjured hemispheres. <b>Conclusion</b>  After brachial plexus injuries, there are interhemispheric differences in GABA concentrations within the sensory and motor cortex. This represents a potential pharmacological target that warrants further investigation.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"20 1","pages":"e16-e25"},"PeriodicalIF":1.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Treatment of Obstetric Plexus Lesions by Direct Coaptation Compared to Sural Nerve Graft Interposition.","authors":"Justus Mai, Christa Kunigunde Raak, Thomas Ostermann, Jörg Bahm, Wolfram Scharbrodt","doi":"10.1055/s-0044-1801398","DOIUrl":"10.1055/s-0044-1801398","url":null,"abstract":"<p><p><b>Background</b>  To date, there are no uniform guidelines for the treatment of obstetric plexus lesions in German-speaking countries. An end-to-end direct suture after resection of trunk neuroma is recommended for surgical treatment if tension-free coaptation is possible, whereas the use of autologous nerve grafts bridging the gap between the adaptation margins is advised by consensus if tension-free coaptation is impossible. <b>Objective</b>  The aim of the study was to investigate which reconstruction strategy may provide a better recovery of motor function for patients after obstetric brachial plexus lesion. <b>Methods</b>  This study compared postoperative functional outcome after obstetric brachial plexus palsy from a patient collective including a total of 43 children. The surgical techniques of plexus reconstruction by end-to-end coaptation versus the use of sural nerve interposition graft have been analyzed. Therefore, the degrees of active motion of abduction and external rotation in the shoulder joint, and flexion in the elbow joint were assessed using the neutral zero method. <b>Results</b>  For abduction in the shoulder joint, significantly better motor function was found in the group with direct sutures ( <i>p</i>  = 0.033). For external rotation in the shoulder joint and flexion in the elbow joint, there was no statistically significant difference between the groups ( <i>p</i>  = 0.284 and <i>p</i>  = 0.270, respectively). <b>Conclusions</b>  This study could not demonstrate absolute superiority of either reconstruction method. Slight evidence was found for a better functional outcome for plexus reconstruction by direct coaptation. Further arguments support a better suitability of plexus reconstruction by direct suture if its use is justifiable.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"20 1","pages":"e9-e15"},"PeriodicalIF":1.1,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}