Otolaryngology- Head and Neck Surgery最新文献

{"title":"Microbiological Profiles and Patterns of Resistance in Patients With Sinus Infections After Endoscopic Sinus Surgery.","authors":"Avraham E Adelman, Akshay Tangutur, Alfredo S Archilla, Gennadiy Vengerovich","doi":"10.1002/ohn.1122","DOIUrl":"10.1002/ohn.1122","url":null,"abstract":"<p><strong>Objective: </strong>Identify common pathogens and antibiotic resistances in chronic rhinosinusitis patients post-endoscopic sinus surgery presenting with an active sinus infection.</p><p><strong>Study design: </strong>Retrospective chart review.</p><p><strong>Setting: </strong>Single-institution rhinology private practice in Southeast Florida.</p><p><strong>Methods: </strong>Recorded postoperative endoscopically-guided sinus cultures from symptomatic patients with purulent drainage on endoscopy from August 2020 to December 2023. When available, pre- or intraoperatively cultured organisms were collected.</p><p><strong>Results: </strong>Of 125 patients, 50.4% were female with a mean age of 51.0. In 34.4% of patients that underwent revision surgery, 76% had nasal polyps and 26.4% had asthma. Of 301 cultures, 264 (87.7%) were positive, 53 (17.6%) were polymicrobial, and 37 (12.3%) were negative. Of 351 total isolates, 165 (47%) were Gram-negative, 125 (35.6%) Gram-positive, 14 (4%) fungi, and 10 (2.8%) anaerobic. 46.9% of postoperative organisms were not cultured preoperatively. Gram-negative bacteria included Enterobacteriaceae (17.7%), Pseudomonas spp. (10.5%), Serratia spp. (5.1%). Gram-positive bacteria included Methicillin-sensitive Staphylococcus aureus (MSSA, 17.1%) and Methicillin-resistant S. aureus (MRSA, 8%). Antibiotic resistances included MSSA to penicillins (52.8%) and clindamycin (32.8%), and MRSA resistance to quinolones (53.6%) and clindamycin (35.7%). Enterobacteriaceae were 42% resistant to amoxicillin-clavulanate and 37.1% to penicillins, while Pseudomonas aeruginosa was 17.7% resistant to quinolones.</p><p><strong>Conclusion: </strong>A cohort of chronic rhinosinusitis patients post-sinus surgery grew a large proportion of Gram-negative organisms and significant Staphylococcal penicillin and Gram-negative amoxicillin-clavulanate resistance. Our findings indicate the benefit of culturing patients with this patient presentation. If cultures cannot be obtained, we suggest broad-spectrum antibiotics that consider wide Gram-negative coverage and local antibiotic resistance patterns.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1442-1449"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932403","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":"In reference to: Combination Tonsillectomy and Hypoglossal Nerve Stimulation for Sleep Apnea Patients with Oropharyngeal Lateral Wall Collapse.","authors":"Eric J Kezirian","doi":"10.1002/ohn.991","DOIUrl":"10.1002/ohn.991","url":null,"abstract":"","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1487-1488"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351438","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":"Neural Radiance Fields (NeRF) for 3D Reconstruction of Monocular Endoscopic Video in Sinus Surgery.","authors":"Jeremy S Ruthberg, Randall Bly, Nicole Gunderson, Pengcheng Chen, Mahdi Alighezi, Eric J Seibel, Waleed M Abuzeid","doi":"10.1002/ohn.1105","DOIUrl":"10.1002/ohn.1105","url":null,"abstract":"<p><strong>Objective: </strong>To validate the use of neural radiance fields (NeRF), a state-of-the-art computer vision technique, for rapid, high-fidelity 3-dimensional (3D) reconstruction in endoscopic sinus surgery (ESS).</p><p><strong>Study design: </strong>An experimental cadaveric pilot study.</p><p><strong>Setting: </strong>Academic medical center.</p><p><strong>Methods: </strong>Complete bilateral endoscopic sinus surgery was performed on 3 cadaveric specimens, followed by postsurgical nasal endoscopy using a 0° rigid endoscope. NeRF was utilized to generate 3D reconstructions from the monocular endoscopic video feed. Reconstructions were calibrated, scaled, and then co-registered to postoperative computed tomography (CT) image sets to assess accuracy. Reconstruction error was determined by comparing ethmoid sinus measurements on NeRF reconstructions and CT image sets.</p><p><strong>Results: </strong>NeRF-based 3D scene reconstructions were successfully generated and co-registered to corresponding CT images for 5 out of 6 cadaveric nasal cavity sides. The mean reconstruction errors and standard error of the mean (SEM) for ethmoid length and height were 0.17 (SEM 0.59) and 0.70 (SEM 0.44) mm, respectively.</p><p><strong>Conclusion: </strong>NeRF demonstrates significant potential for dynamic, high-fidelity 3D surgical field reconstruction in ESS, offering submillimeter accuracy comparable to postoperative CT data in cadaveric specimens. This innovative approach may ultimately augment dynamic real-time intraoperative navigation through co-registration of the 3D reconstruction with preoperative imaging to potentially reduce the risk of injury to critical structures, optimize surgical completeness and, thereby, improve surgical outcomes. Further refinement and validation in live surgical settings are necessary to fully realize its clinical utility.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1435-1441"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952702","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":"Clinician Perspectives on the Management of Hearing Loss in Patients With Limited English Proficiency.","authors":"Aparna Govindan, Adina Singer, Lily Zekavat, Tianyi Jia, Kevin Wong, Jianjing Kuang, Maura K Cosetti, Tiffany P Hwa","doi":"10.1002/ohn.1089","DOIUrl":"10.1002/ohn.1089","url":null,"abstract":"<p><strong>Objective: </strong>Clinicians face challenges in managing the growing population of patients with limited English proficiency (LEP) and hearing loss (HL) in the United States. This study seeks to investigate provider perspectives on evaluating, counseling, and treating HL in LEP patients.</p><p><strong>Study design: </strong>Prospective descriptive study.</p><p><strong>Setting: </strong>Tertiary care center.</p><p><strong>Methods: </strong>Researchers employed a mixed methods design: (1) structured clinician interviews, (2) cross-sectional, national electronic survey, both regarding perspectives on managing hearing loss in LEP patients. Structured interviews were analyzed using modified grounded theory.</p><p><strong>Results: </strong>Twenty-nine providers participated in interviews (16 otologists, 13 audiologists). The most reported non-English language was Spanish, followed by Chinese languages. Four thematic domains were derived: barriers to care, cochlear implant (CI) candidacy evaluation, counseling, and ideal resources. Major barriers were patient desire (97%; n = 28), and lack of validated tests (72%; n = 21). Methods of CI evaluation included improvising on validated speech perception testing (59%; n = 17) and use of non-speech evaluation (52%; n = 15). One-quarter forgoes speech testing in non-Spanish-speaking patients (24%; n = 7). Suggestions to improve management include in-person interpreters (62%; n = 18) and testing battery in all languages (31%; n = 9). National survey results (n = 87 providers) demonstrated that respondents were significantly less confident in the methods of speech perception testing and in counseling on surgical hearing rehabilitation in LEP.</p><p><strong>Conclusion: </strong>Clinicians encounter challenges in managing LEP patients with HL, including limitations in audiometric and CI candidacy assessment, communication barriers, information accessibility, and cultural competency. Opportunities for improving care include developing language-specific test batteries, linguistically and culturally appropriate education materials, and cultural competency training.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1232-1241"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896367","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":"Transient Global Amnesia After Endoscopic Septoplasty and Turbinate Reduction.","authors":"Arifeen S Rahman, Peter H Hwang, David T Liu","doi":"10.1002/ohn.1135","DOIUrl":"10.1002/ohn.1135","url":null,"abstract":"","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1491-1492"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009318","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":"The Association Between Hearing Loss and Depression in a Large Electronic Health Record System.","authors":"Hannah N W Weinstein, Lauren H Tucker, Maeher R Grewal, Michael W Denham, Katharine K Brewster, Justin S Golub","doi":"10.1002/ohn.1136","DOIUrl":"10.1002/ohn.1136","url":null,"abstract":"<p><strong>Objective: </strong>Hearing loss (HL) is associated with depression, but existing datasets are limited by the type of data available for both hearing and mental health conditions. The purpose of this study is to determine if there is an association between HL and depressive disorders within a large bi-institutional electronic health record (EHR) system containing more granular diagnostic information.</p><p><strong>Study design: </strong>Cross-sectional epidemiologic study.</p><p><strong>Setting: </strong>Two academic medical centers.</p><p><strong>Methods: </strong>Audiometric data was collected from patients ≥18 years old between 2020 to mid-2023 (n = 29,772). The exposure was HL defined as the 4-frequency pure-tone average (PTA), speech reception threshold (SRT), and word recognition score (WRS). The outcomes were depression, categorized as either: (1) major depressive disorder, defined by International Classification of Diseases, 10th Revision (ICD-10) code; (2) persistent mood disorder, defined by ICD-10 code; or (3) antidepressant medication use, defined by medication lists. Odds ratios were computed from logistic regressions between HL and each of the outcome variables, controlling for age, sex, cardiovascular risks, and site.</p><p><strong>Results: </strong>The mean age (standard deviation) was 60.5 (18.2) years, and 17,736 participants (59.6%) were female. Controlling for covariates, for every 10-dB worsening in hearing by PTA, the odds of major depressive disorder increased by 1.04 times (95% confidence interval [CI] = 1.01-1.07, P = .015). Similarly, for every 10 dB worsening in hearing by PTA or SRT, the odds of antidepressant medication use increased by 1.04 times (95% CI = 1.01-1.06, P = .004). Odds ratios for persistent mood disorder were nonsignificant.</p><p><strong>Conclusion: </strong>In a large academic EHR, HL is associated with major depressive disorder and antidepressant medication use.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1262-1271"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047315","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":"Complications Following Surgical Management of Zenker Diverticulum: A Comparative Analysis of Endoscopic and Open Approaches.","authors":"Jefferson DeKloe, Samuel R Shing, Lia Herzig, Dylan Bertoni, Kathleen M Tibbetts","doi":"10.1002/ohn.1119","DOIUrl":"https://doi.org/10.1002/ohn.1119","url":null,"abstract":"<p><strong>Objective: </strong>We aim to explore the differences in complication rates in endoscopic versus open transcervical treatment of Zenker diverticulum.</p><p><strong>Study design: </strong>Retrospective Cohort Study from January 1, 2015 to December 31, 2023.</p><p><strong>Setting: </strong>Queries of the TriNetX database's United States Collaborative Network.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using patients ≥18 years old diagnosed with Zenker diverticulum selected from the TriNetX United States Collaborative Network. Patients undergoing open and endoscopic diverticulectomy between 2015 and 2023 were identified and divided into cohorts and propensity score matched by age, sex, race, ethnicity, and common comorbidities.</p><p><strong>Results: </strong>Patients that underwent transcervical approach (n = 1033), when compared to patients that underwent endoscopic approach (n = 2182), had higher rates of dysphonia (odds ratio [OR]: 2.44; 95% confidence interval [CI]: 1.47-4.05; P = .001), long-term enteral feeding access (OR: 3.08; 1.74-5.46; P > .001), and infection (OR: 6.65; 3.50-12.65; P > .001). No significant difference was found in rates of esophageal perforation (OR: 1.60; 0.93-2.75; P = .087) or persistent postoperative dysphagia (OR: 1.03; 0.86-1.23, P = .75). There was no significant difference in the number of patients receiving repeat diverticulectomy procedures (OR: 0.83; 0.58-1.19; P = .314).</p><p><strong>Conclusion: </strong>Based on analysis of a large healthcare database, endoscopic Zenker diverticulectomy is associated with rates of postoperative dysphonia, enteral feeding, and soft tissue infection. Both the open and endoscopic approaches offer relative advantages not captured by this population-level analysis. Thus, judicious selection of patients based on comorbidities and anatomical factors is essential for optimizing outcomes.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":"172 4","pages":"1328-1333"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720940","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":"Financial Impact of Medicare Payment Reform for E/M Visits on Compensation for Otolaryngologic Procedures in 2023.","authors":"Lauren E Miller, Ashley L Miller, James W Rocco, Vinay K Rathi","doi":"10.1002/ohn.1146","DOIUrl":"10.1002/ohn.1146","url":null,"abstract":"<p><p>The Centers for Medicare & Medicaid Services (CMS) recently increased payment for evaluation and management (E/M) visits, but did not apply these updates to post-operative global period visits. We investigated the resulting Medicare fee-for-service revenue loss for otolaryngologists. Using publicly available Medicare spending/utilization data, we estimated how much additional payment otolaryngologists would have received in 2023 if CMS had reimbursed global period visits at the same rates as other E/M visits. Our analysis included 291 procedures with 10- or 90-day global periods. The total estimated global period revenue loss was $7.0 M and concentrated among facial plastic/reconstructive ($3.3 M; 47.1%), head and neck ($1.5 M; 21.4%), and otologic ($1.2 M; 17.1%) procedures. Total estimated losses were greatest for nasal septoplasty (CPT 30520; $1.2 M), tympanostomy with ventilating tube placement (CPT 69433; $0.6 M), and cervical lymphadenectomy (CPT 38724; $0.5 M). Payment reforms based on robust and empirically-derived measures of physician work are necessary to promote fair procedural compensation.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1281-1285"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046789","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}

{"title":"Disparities in Survival of Head and Neck Cancer in the Hispanic Population: Systematic-Review and Meta-analysis.","authors":"Alejandro R Marrero-Gonzalez, Douglas P Nanu, Shaun A Nguyen, Emily A Brennan, William Greer Albergotti, Bhisham S Chera, Jennifer L Harper, John M Kaczmar, Alexandra E Kejner, Jason G Newman, Judith M Skoner, Evan M Graboyes","doi":"10.1002/ohn.1113","DOIUrl":"10.1002/ohn.1113","url":null,"abstract":"<p><strong>Objective: </strong>The Hispanic health paradox (HHP), the observation that Hispanic people in the United States often experience better health outcomes than non-Hispanic people despite having worse prognostic factors, has not been evaluated for patients with head and neck squamous cell carcinoma (HNSCC), a malignancy with marked racial disparities in outcomes. The objective of this study is to evaluate the HHP within the context of HNSCC.</p><p><strong>Data sources: </strong>CINAHL, PubMed, and Scopus.</p><p><strong>Review methods: </strong>Studies that compared survival between Hispanic and non-Hispanic patients with HNSCC in the United States were included. Meta-analysis of adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) was conducted to compare overall survival (OS) and cancer-specific survival (CSS) between Hispanic white (HW) and non-Hispanic white (NHW) patients with HNSCC.</p><p><strong>Results: </strong>Of 2106 unique abstracts reviewed, 25 studies were included in the systematic review and 22 in the meta-analysis. Among the 657,185 patients in the meta-analysis, 6.9% (95% CI: 5.8%-8.3%) were of Hispanic ethnicity. HW patients had improved OS relative to NHW patients (aHR = 0.90, 95% CI: 0.86-0.94) among the 17 studies reporting OS and improved CSS relative to NHW patients (aHR = 0.87, 95% CI: 0.80-0.94) among the 4 studies reporting this outcome.</p><p><strong>Conclusion: </strong>HW people with HNSCC exhibit improved survival relative to NHW people with HNSCC, supporting the HHP in the context of HNSCC. Research is needed to understand the underlying mechanisms, which could provide insights into improving outcomes for all patients with HNSCC.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1177-1191"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932387","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}

{"title":"Association of Polycystic Ovary Syndrome With Sensorineural Hearing Loss: A Systematic Review and Meta-analysis.","authors":"Tai-Yu Chen, Mei-Jou Chen, Kuang-Hsu Lien","doi":"10.1002/ohn.1081","DOIUrl":"10.1002/ohn.1081","url":null,"abstract":"<p><strong>Objective: </strong>Despite certain studies indicating hearing impairments in individuals with polycystic ovary syndrome (PCOS), the correlation between PCOS and sensorineural hearing loss (SNHL) remains inconclusive. This study aimed to investigate the association between PCOS and SNHL.</p><p><strong>Data sources: </strong>A systematic literature search was conducted using PubMed, MEDLINE, EMBASE, and the Cochrane Library from inception to June 24, 2024.</p><p><strong>Review methods: </strong>This meta-analysis included cross-sectional, case-control, or cohort studies examining the association between PCOS and SNHL without language or regional restrictions. Case reports, case series, animal studies, and in vitro studies were excluded. We adhered to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and utilized the Newcastle-Ottawa Scale to assess the risk of bias in the included studies.</p><p><strong>Results: </strong>After performing the systematic review, we conducted a meta-analysis that included 489 patients from 5 studies: 349 patients with PCOS and 140 age- and sex-matched controls without PCOS. The meta-analysis compared the mean differences in frequency-specific pure-tone thresholds between patients with PCOS and matched controls, providing 95% confidence intervals for these differences. Given the expected clinical heterogeneity, we employed the DerSimonian and Laird random-effects model. Our results revealed significant hearing loss at specific frequencies (1000, 4000, 8000, 10,000, 12,000, 14,000, 16,000, 18,000, and 20,000 Hz) in the PCOS group compared to the control group (P < .05). Furthermore, the degree of hearing loss is greater at higher frequencies.</p><p><strong>Conclusion: </strong>This meta-analysis demonstrated an association between PCOS and SNHL, particularly at higher frequencies.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1121-1132"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886160","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}