Neurosurgical focus最新文献

{"title":"The Co-Pilot Project in wartime: lessons from Lviv, Ukraine.","authors":"Christopher Markosian, Oleksandr Strelko, Jeff F Zhang, Viktoriia Kuts-Karpenko, Peter Shapiro, Roksolana Vaskul, Mykhailo Lovha, Yuriy Flys, Maksim Shapiro, Jonathan A Forbes, Luke D Tomycz","doi":"10.3171/2024.12.FOCUS24602","DOIUrl":"10.3171/2024.12.FOCUS24602","url":null,"abstract":"<p><strong>Objective: </strong>The ongoing war in Ukraine has introduced many challenges to an already overburdened and resource-limited medical system. Longitudinal collaborations, material support, educational outreach, and surgical mentorship are essential for improving outcomes and standards of neurosurgical care in extreme settings such as in times of war.</p><p><strong>Methods: </strong>Operating in Ukraine since 2016 through the coordination of Razom, the Co-Pilot Project has organized multiple United States-based mission trips to Ukraine to support local physicians during wartime, including a trip between April and May of 2023.</p><p><strong>Results: </strong>A team of two anesthesiologists, two neurosurgeons, a neurointerventional radiologist, and an industry representative providing technical expertise aided in the instruction and performance of complex neurosurgical and neurovascular procedures by Ukrainian physicians at St. Panteleimon Hospital and St. Nicholas Children's Hospital in Lviv. Such efforts are crucial for helping to address the sharp rise in elective neurosurgical volume caused by the increase in internally displaced persons in Western Ukraine since February 2022. In an illustrative case, the authors provide an in-depth description of a foramen magnum meningioma resection via a far lateral craniotomy in a 48-year-old female.</p><p><strong>Conclusions: </strong>Despite the supply shortages and logistical challenges brought on by war, the Co-Pilot Project continues to utilize a long-term approach to continually improve the operative capabilities of Ukrainian neurosurgeons through both in-person and virtual collaborations. It is hoped that the lessons learned from a recent trip to Ukraine will help to inform and inspire other global neurosurgery initiatives in the future.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 3","pages":"E16"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the gaps in the setup of a functional epilepsy monitoring unit in Uganda to support epilepsy surgery.","authors":"Emmanuel Wegoye, David Bieber, Shadrack Khisa, Khrystyna Moskalyk, Brenda Mutonyi, Betty Nantongo, Richard Idro, Mariana Vicenteno, Erik Padilla, Sunny Abdelmageed, Roxanna M Garcia, Robert Sebunya, Humphrey Okechi, Elysa Widjaja, Sandi Lam","doi":"10.3171/2024.12.FOCUS24808","DOIUrl":"10.3171/2024.12.FOCUS24808","url":null,"abstract":"<p><p>As many as 80 million people in the world have epilepsy. Those living in the developing world are disproportionately affected. Approximately 770,000 people in Uganda are affected by epilepsy. Drug-resistant epilepsy affects approximately 30%-40% of patients with epilepsy, and one-third of these patients may be eligible for surgical management. This article describes the formation of an epilepsy monitoring unit in Uganda as the first step toward establishing a surgical epilepsy program for pediatric patients. A hybrid remote and in-person collaborative model was developed between teams in Mbale and Kampala in Uganda and Chicago in the US. The authors describe a process that spanned 2 years (2021-2023) for developing readiness for referrals for pediatric epilepsy surgery candidates in Uganda.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 3","pages":"E7"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction. Advances in global neurosurgery: citius, altius, fortius-communiter.","authors":"Kee B Park, Robert Dempsey, Gail Rosseau, Tariq Khan, Franco Servadei","doi":"10.3171/2024.12.FOCUS24601","DOIUrl":"10.3171/2024.12.FOCUS24601","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 3","pages":"E1"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Female authorship in global research: a bibliometric study of high- and low-income country collaborations.","authors":"Francesca Totis, Filippo Emanuele Colella, Adrian Safa, Roberto Stefini, Delia Cannizzaro","doi":"10.3171/2024.12.FOCUS24815","DOIUrl":"10.3171/2024.12.FOCUS24815","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to examine female authorship in research from collaborations between high-income countries (HICs) and lower-middle-income and low-income countries (LMICs/LICs) across two time periods: 2018-2020 and 2021-2023.</p><p><strong>Methods: </strong>A bibliometric analysis of neurosurgical research articles from the Scopus database, published between 2018 and 2023, was performed to investigate collaboration trends between HICs and LMICs/LICs. Only neurosurgical publications were included, and female authors were identified based on names traditionally associated with female gender identity, verified through online searches and tools such as Genderize.io. Articles with more than 25 authors, commentaries, letters, and news items were excluded to ensure a focus on original research. The selected articles spanned various neurosurgical specialties and were restricted to English-language journals with an impact factor greater than 1. The country affiliations of first, corresponding, and last authors were categorized using the 2018 World Bank classification to understand collaboration patterns across income levels.</p><p><strong>Results: </strong>The analysis revealed a steady increase in neurosurgical publications from 2018 to 2023, with a notable rise in the second triennium (2021-2023). Authors from HICs consistently held the majority of first, corresponding, and last authorship positions. Concerning first authorship, authors with affiliations from HICs increased from 66% in the first triennium to 75% in the second. Similarly, corresponding authors from HICs increased from 75% to 82% over the same period. Male authors dominated all key authorship roles, with 127 male-led first authorships compared with 46 female-led first authorships in the second triennium. This male predominance persisted in corresponding and last author roles as well.</p><p><strong>Conclusions: </strong>Global neurosurgical research is growing but significant gender disparities persist, especially in LMICs/LICs, with female researchers underrepresented in key authorship roles, requiring targeted efforts to address systemic barriers and promote gender equity in academic leadership.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 3","pages":"E14"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fifteen years and beyond: wins and challenges of the Tanzania Neurosurgery Project.","authors":"Magalie Cadieux, Hamisi K Shabani, Roger Härtl","doi":"10.3171/2024.12.FOCUS24620","DOIUrl":"10.3171/2024.12.FOCUS24620","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 3","pages":"E17"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Significance, applications, and contributions of Gamma Knife radiosurgery in advancing neurosurgical care in lower-middle-income countries: a systematic review.","authors":"Sudharman Sitaraman, Bhavya Pahwa, L Dade Lunsford, Varun Rao","doi":"10.3171/2024.12.FOCUS24760","DOIUrl":"10.3171/2024.12.FOCUS24760","url":null,"abstract":"<p><strong>Objective: </strong>Gamma Knife radiosurgery (GKRS) is an important neurosurgical intervention most commonly used for pathologies such as meningiomas, acoustic neuromas, paragangliomas, arteriovenous malformations, and trigeminal neuralgia. While the widespread availability of GKRS in developed countries makes it ubiquitous in neurosurgical research, there is a huge disparity in research in lower-middle-income countries (LMICs). This study aimed to quantify research undertaken by authors in LMICs on GKRS.</p><p><strong>Methods: </strong>The authors systematically reviewed PubMed for research articles that reported on GKRS from LMICs. Studies reporting on neurosurgically treated pathologies in which either the first or corresponding author was affiliated with an institution in an LMIC were included.</p><p><strong>Results: </strong>A total of 190 papers from LMICs met the criteria; 142 articles were from Asia and 48 were from Africa. India had the highest number of papers, whereas no papers from LMICs in South America or Oceania met the criteria for inclusion. The most frequently published type of study was retrospective, tumors were the most common pathologies studied, and arteriovenous malformations were the single most studied individual pathology. There was no significant difference in the mean number of each article type or for neoplastic, vascular, or functional pathologies per country between Asia and Africa. Articles were most often published in Neurology India, and 24 studies had a female first author, whereas 22 had a female corresponding author.</p><p><strong>Conclusions: </strong>This study reveals the relatively low number of studies providing high-quality evidence from LMICs such as randomized controlled trials and meta-analyses, as well as gender inequities and very high disparities among LMICs in GKRS research.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 3","pages":"E9"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of the 6 pillars of sustainable global surgical partnerships by the Neurosurgery Outreach Foundation with lower-middle-income countries in Asia.","authors":"Philipp Aldana, Carmina Aldana, Ricardo A Hanel, Wyben Briones, Jaime Rama, Reynaldo Benedict V Villamor, Charles Tan, Roland Mark M Gigataras, Gerardo D Legaspi, Ronnie E Baticulon, Kathleen Joy O Khu, Shirchinjav Altantuya, Tovuudorj Bolormaa, Davaasambuu Enkhmaa, Patricia Clerkin, Eylem Ocal, Wayne Gluf, Ariana Barkley, Salvador F Gutierrez-Aguirre, Belinda Shao, Stephen Pirris","doi":"10.3171/2025.1.FOCUS24828","DOIUrl":"10.3171/2025.1.FOCUS24828","url":null,"abstract":"<p><strong>Objective: </strong>The global need for neurosurgical care is significant and often unmet. Building partnerships between high-income countries (HICs) and lower-middle-income countries (LMICs) can help bridge the gap. Six features of sustainable global surgical partnerships have been identified; however, their application in neurosurgery has not been studied. The authors analyzed how the 6 pillars of sustainability are applied to neurosurgical partnerships established by the Neurosurgery Outreach Foundation (NOF) with hospitals in LMICs in Asia.</p><p><strong>Methods: </strong>NOF is an all-volunteer, nonprofit US foundation with the mission to advance neurosurgical care in underserved communities through education, service, and support. The authors examined the NOF programs and identified the characteristics associated with the 6 pillars of sustainability, which are community engagement, multidisciplinary collaboration, education and training, outcome measurement, multisource funding, and bilateral authorship. The authors discuss how these pillars contribute to the establishment of sustainable partnerships.</p><p><strong>Results: </strong>From 2010 to 2024, NOF has established partnerships at 4 sites: Cebu, Manila, and Davao, the Philippines; and Ulaanbaatar, Mongolia. Partnerships were established with tertiary or quaternary government hospitals to develop neurosurgical programs tailored to the needs of each site and remained sustained and active. Educational surgical missions were in-person outreach activities conducted annually or biennially and were supplemented with online or remote collaboration. The 5 pillars of sustainable partnerships present at all sites include community engagement, multidisciplinary collaboration, education and training, outcome measurement, and multisource funding. The sixth pillar, bilateral authorship, was present at University of the Philippines-Philippine General Hospital in Manila.</p><p><strong>Conclusions: </strong>Using the 6 pillars of sustainable global partnerships, neurosurgical partnerships can be developed and maintained by all-volunteer nonprofit organizations such as NOF. Incorporating these pillars during the planning and executing of global neurosurgical partnerships are essential for long-term success.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 3","pages":"E15"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging global neurosurgical gaps: the potential role of medical students in Europe.","authors":"Adrian Safa, Chiara Zancanella, Carlo Cossa, Matteo Scalise, Jacopo Rosso Antonino, Katrina Espinar-Herranz, Simone Laguardia, Carlotta Dell'Anna Misurale, Lorenzo Pavia, Carina Ribeiro Graca, Tevfik Serhan Bora, Ludovico Orbecchi, April Sabangan, Alfredo Quiñones-Hinojosa","doi":"10.3171/2024.12.FOCUS24807","DOIUrl":"10.3171/2024.12.FOCUS24807","url":null,"abstract":"<p><strong>Objective: </strong>Unmet global neurosurgical needs pose a significant challenge, as do unequal opportunities for neurosurgical education and training across the globe. Mission:BRAIN is a nonprofit organization working to provide neurosurgical expertise and resources to both patients and healthcare providers in underserved areas. It operates globally, with local chapters involving primarily medical students. Its presence in Europe has expanded in the last few years with initiatives that contribute to shaping an international approach to global neurosurgery challenges. The authors aim to investigate the impact of student-led organizations, such as Mission:BRAIN, on global neurosurgery, with a focus on low-income countries and low- to middle-income countries, while also assessing the changes observed within the European group during its initial 2 years.</p><p><strong>Methods: </strong>Quantitative and qualitative analyses were employed to investigate changes in the number of chapters, members, and events. The perceived impact was evaluated using a Likert scale survey administered to European members.</p><p><strong>Results: </strong>Between 2022 and 2023, the number of European chapters increased by 150% (n = 10) and memberships doubled. Of the 102 survey respondents, 56.9% were female and 42.2% were male. Similarly, the number of events grew by 240%, with a significant increase in educational events (325%, p = 0.007). Participation in events increased by 10.13%, reflecting growing interest and engagement. For most members (72.6%), the activities in the European region have increased global awareness of the importance of neurosurgical care in underserved areas; for 45.1% of them, outreach events have effectively communicated the importance of neurosurgical care to nonmedical audiences. For 67.6% of the members, European chapters have contributed to fostering collaboration and knowledge sharing among medical students and healthcare providers. Furthermore, 59% agreed that Mission:BRAIN initiatives have contributed to addressing disparities in neurosurgical care and education.</p><p><strong>Conclusions: </strong>Mission:BRAIN's growth in Europe showcases the pivotal role of medical students. The impact of the organization's activities demonstrates the students' potential to contribute to the overarching effort of bridging worldwide gaps in healthcare and education and calls for their active participation and recognition.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 3","pages":"E12"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telerehabilitation and cost analysis in global neurosurgery: a systematic review and meta-analysis of 40,537 patients.","authors":"Shahaan S Razak, Fabricio Garcia-Torrico, Caitlyn J Smith, Amal H Khiralla, Soneesh Kothagundla, Diana L Ochoa Hernandez, Bryan D Choi, Ganesh M Shankar, Mohammad A Aziz-Sultan, Brian V Nahed","doi":"10.3171/2024.12.FOCUS24830","DOIUrl":"10.3171/2024.12.FOCUS24830","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative rehabilitation is crucial for neurosurgical patients' rehabilitation, but access in low- and middle-income countries (LMICs) is often limited. Telerehabilitation offers a cost-effective, accessible alternative by providing remote therapy through digital platforms. This study compared telerehabilitation with traditional methods in LMICs, focusing on cost-effectiveness, clinical outcomes, and patient satisfaction.</p><p><strong>Methods: </strong>A systematic review was conducted using PRISMA guidelines, with searches across PubMed, Embase, IEEE Xplore, and Web of Science. Studies were included if they focused on telerehabilitation for neurosurgical patients in LMICs and assessed cost-effectiveness or cost savings, along with clinical outcomes. Data extraction and quality assessments were performed using Covidence, with risk of bias evaluations conducted with the ROBINS-I tool.</p><p><strong>Results: </strong>The authors' review included 20 studies with 40,537 neurosurgical patients, demonstrating telemedicine's role in patient care, from initial consultations to postoperative follow-ups. Cost analysis revealed specific savings such as $61.80 per patient in India for neurosurgical follow-ups, $888 to $1501 per visit in the US for patients from underserved areas, and $3.8 million in stroke and injury care in France. Patient satisfaction showed an average rate of 97% (95% CI 94%-98%, p = 0.06). Additionally, the combined analysis estimated an 88% probability of achieving a favorable outcome (95% CI 68%-96%, p < 0.01). Intervention efficiency revealed a rate of 97% (95% CI 96%-99%, p < 0.0001).</p><p><strong>Conclusions: </strong>Telerehabilitation in neurosurgical care for LMICs offers a transformative solution, dramatically reducing healthcare costs, improving access, and maintaining the quality of care. With proven effectiveness across large patient populations, telemedicine bridges critical gaps in neurosurgical treatment, highlighting an urgent global need to scale its implementation. This technology could revolutionize healthcare in resource-limited settings, mitigating the geographic, financial, and infrastructural barriers that have long hindered equitable neurosurgical care worldwide.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 3","pages":"E8"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing global microneurosurgery education and laboratory training during and after the COVID-19 pandemic: from challenges to innovations.","authors":"Abdullah Keles, Selin Bozdag, Burak Ozaydin, Robert J Dempsey, Mustafa K Baskaya","doi":"10.3171/2024.12.FOCUS24829","DOIUrl":"10.3171/2024.12.FOCUS24829","url":null,"abstract":"<p><strong>Objective: </strong>The COVID-19 pandemic posed significant global challenges, particularly in its disruption of surgical education, training, and research. The University of Wisconsin (UW)-Madison Microneurosurgery Laboratory, an internationally recognized training center, had to rapidly adapt to continue its mission amid pandemic restrictions. In this study the authors evaluated their laboratory's response during and after the pandemic, focusing on the challenges encountered, innovative strategies used, and their impact on ongoing operations and global neurosurgery outreach.</p><p><strong>Methods: </strong>A retrospective review was conducted of the UW-Madison Microneurosurgery Laboratory's operations and global neurosurgery outreach efforts from the onset of the COVID-19 pandemic to the present, focusing on the challenges encountered and the innovations implemented. An online survey was also conducted to gather data on fellows' experiences in the post-COVID-19 era. Descriptive and inferential statistical analyses were used to evaluate the data.</p><p><strong>Results: </strong>The review revealed that the COVID-19 pandemic significantly impacted the laboratory's operations and global outreach, prompting adaptations to maintain training continuity. From March 2020 to April 2021, strict restrictions limited in-person activities, but innovative solutions such as remote teaching, virtual courses, and distributed training kits helped sustain microsurgical education. After restrictions eased, the authors' laboratory resumed hands-on training and expanded outreach efforts.</p><p><strong>Conclusions: </strong>The COVID-19 pandemic prompted transformative innovations in surgical training at the UW-Madison Microneurosurgery Laboratory, including the adoption of remote teaching, home training kits, and the Madison Objective Self-Assessment Tool. These adaptations ensured training continuity and expanded global access, particularly in low- and middle-income countries. The lessons learned have shaped a sustainable hybrid training approach that continues to enhance neurosurgical education and address barriers to access.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 3","pages":"E11"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}